TRISTAR Insurance Group · 1 day ago
Workers Compensation Claims Examiner III (Albuquerque, Phoenix, Denver, Salt Lake City, Las Vegas)
Phoenix Office - Phoenix, AZ 85014
Full-time
Hybrid
Mid, Senior Level
$75K/yr - $85K/yr
5+ years expTRISTAR Insurance Group is a company specializing in insurance services, and they are seeking an experienced Workers Compensation Claims Examiner III. This role involves managing all aspects of indemnity claims handling, requiring considerable interaction with clients and other stakeholders to ensure timely and effective resolution of claims.
Financial ServicesInsuranceRisk Management
Responsibilities
Effectively manages an average caseload of 130 workers’ compensation files, including very complex claims
Initiates and conducts investigation in a timely manner
Determines compensability of claims and administers benefits, based upon state law and in accordance with established Company guidelines
Develops and manages claims through well-developed action plans; continues to work the action plan to stay on task and to bring the claim to an appropriate and timely resolution
Manages medical treatment and medical billing, authorizing as appropriate
Calculates and pays benefits due and approves all claim payments
Refers cases to outside defense counsel. Directs and manages as appropriate
Manages claim recoveries of all types, including deductible and subrogation
Communicates with clients, claimants, providers and vendors regarding claims issues
Computes and set reserves within Company guidelines
Settles and/or finalizes all claims and obtains authority as designated
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
Adheres to all Company policies and procedures
Conducts file reviews independently
Other duties as assigned
Qualification
Required
High School Diploma or GED
Bachelor's degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience
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
Certifications and/or licenses as required by State regulation
Preferred
Bachelor's degree in related field
Proficient in Word and Excel
Knowledge of self-insured claims handling
City, County and/or District claims handling experience
Company
TRISTAR Insurance Group
Tristar Insurance Group provides excellent claims and risk management services to a variety of clients.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Denise Cotter
Chief Financial Officer
Linda Naif
Chief Information Officer
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