• Claims Examiner I - WC

    Job Location(s) US-TX-Corpus Christi
    Job ID
    2018-1631
    # of Openings
    1
    Category
    Worker's Compensation
    Job Type
    Regular Full-Time
  • Overview

     

     

    TRISTAR Insurance Group began as an insurance program manager and medical malpractice claims administrator in 1987. Workers compensation claims management services were added in our offerings in 1989, and the Company was renamed TRISTAR Risk Management in 1995. As managed care and benefits administration services were added to our offerings, the organization grew into TRISTAR Insurance Group.

    Since our merger with Risk Enterprise Management in 2012, we became the largest privately held third party claims administrator. We empower more than 1,000+ professionals in offices throughout the United States, focusing business operations in three divisions: property casualty claims management, benefits administration, and managed care services.

    We are true to our values of RESPECT, INTEGRITY, TRUST, and EXCELLENCE, making the right choices both financially and ethically.

    At TRISTAR we strive to create an environment of respect, wherein all of us are encouraged to learn and to grow, to provide exceptional service to our clients and in turn to enjoy the satisfaction that comes from a job well done. We believe that to provide real service, we must contribute something which cannot be bought or measured with money: sincerity and integrity.

    At TRISTAR, you help create a world in which together we "transform risk into opportunity".

    Responsibilities

    POSITION: CEI  MedicalOnly Claims Examiner

     

     

    POSITION SUMMARY: Under close supervision manages all aspects of medical only and handling from inception to conclusion within established authority and guidelines.

    This position requires considerable interaction with clients, claimants on the phone, and with management, other Claims Examiners, and other TRISTAR staff in the office; therefore consistently being at work in the office, in a timely manner, is inherently required of this posiition.

     

    DUTIES AND RESPONSIBILITIES:

     

    • Effectively manages an assigned medical only caseload of not more than 250 workers compensation claim.*
    • Initiates and conducts 2 point contacts in a timely manner pursuant to Client and TRISTAR Best Practices.*
    • Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.*
    • Manages medical treatment and medical billing, authorizing as appropriate.
    • Refers cases to Indemnity Examiner if claims meet indemnity conversion qualification per Tristar best practices.
    • Communicates with claimants, providers and vendors regarding claims issues.*
    • Limits are $5000.00 and once met the claim is referred to the Indemnity Examiner.*
    • Maintains diary system for case review and document file to reflect the status of and work being performed on the file.*
    • Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.*
    • Adheres to all Company policies and procedures.*
    • Other duties as assigned.

    *Essential job function.

    Qualifications

    QUALIFICATIONS REQUIRED:

     

    Education/Experience: Bachelor's degree in related field (preferred); and one (1) year rellated experience; or equivalent combination of education and experience.

    Knowledge.

     

    Ski lls and Abilities:

    • Technical knowledge of statutory regulations and mediical terminology.
    • Analytical skills.Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
    • Abilliity to interact with persons at all levels in the business environment.
    • Proficient in Word and Excel (preferred).

     

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