• Claims Examiner II - WC

    Job Location(s) US-TX-Irving
    Job ID
    2018-1636
    # 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 SUMMARY:  Under general supervision manages all aspects of indemnity claims 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 position.

     

     

    DUTIES AND RESPONSIBILITIES:

     

    • Effectively manages a caseload of 150 to 180 workers’ compensation files, including complex claims.*
    • Initiates and conducts claims investigation in a timely manner.*
    • 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 outside defense counsel as appropriate.  Monitors legal aspects.*
    • Communicates with claimants, providers and vendors regarding claims issues.*
    • Computes and set reserves within Company guidelines.  Limits are less than those allowed for Claims Examiner III, but larger than those for Claims Examiner I.*
    • Settles and/or finalize all claims and obtains authority as designated.*
    • Maintains diary system for case review and document file to reflect the status 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.*
    • Involves TRISTAR loss control staff when appropriate.*
    • Adheres to all Company policies and procedures.*
    • Participates in file reviews, as needed.
    • Other duties as assigned.

     

    *Essential job function.

    Qualifications

    Education/Experience:  Bachelor’s degree in related field (preferred); and one (1) to five (5) years related experience; or equivalent combination of education and experience.  High school diploma or GED required.

     

    Knowledge, Skills and Abilities:

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

     

    Other Qualifications

    • Texas Workers Compensation License

    Options

    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed