• Workers Compensation Claims Examiner I

    Job Location(s) US-CA-Alhambra
    Job ID
    2018-1653
    # of Openings
    2
    Category
    Worker's Compensation
    Job Type
    Regular Full-Time
  • Overview

    POSITION SUMMARY:  Under close 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.

    Responsibilities

    DUTIES AND RESPONSIBILITIES:

     

    • Effectively manages a caseload of indemnity workers’ compensation files with supervison.*
    • Initiates and conducts investigation in a timely manner based upon state law and TRISTAR Best Practices for claim handling with direction from supervisor.*
    • Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines with direction from supervisor.*
    • Manages medical treatment and medical billing, authorizing as appropriate based on City of Los Angeles claims handling guidelines.*
    • Triggers litigated cases with City Attorney with supervisor to establish plan of action and obtain settlement authority to commence settlement negotiations with Applicant Attorney.* 
    • Communicates with claimants, providers and vendors regarding claims issues.*
    • Maintains diary system for case review and document file to reflect the status and work being performed on the file.*
    • Computes and set reserves based upon City of Los Angeles claims handling guidelines with direction from supervisor.*
    • Negotiates and/or finalize all claims based on settlement authority obtained from City Monitor or City Attorney with direction from supervisor.*
    • Maintains diary system for case review and documents 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 with direction from supervisor.*
    • Adheres to all TRISTAR company policies and procedures.*
    • Conducts ongoing file reviews with supervisor for development.*
    • Other duties as assigned by supervisor.

     

    *Essential job function.

    Qualifications

    QUALIFICATIONS REQUIRED:

     

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

     

    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 people at all levels in the business environment.
    • Ability to effectively manage claims with high level of supervision.
    • Proficient in Word and Excel (preferred).

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