Workers Compensation Claims Examiner

2 weeks ago

Signal Hill, California, United States Tristar Insurance Services LLC Full time
Job Summary

We are seeking a highly skilled Workers Compensation Claims Examiner I to join our team at Tristar Insurance Services LLC. As a key member of our claims team, you will be responsible for managing all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.

Key Responsibilities
  • Effectively manage a caseload of indemnity workers' compensation files with supervision.
  • Initiate and conduct investigations in a timely manner based on state law and Tristar Best Practices for claim handling with direction from supervisor.
  • Determine compensability of claims and administer benefits based on state law and in accordance with established Company guidelines with direction from supervisor.
  • Manage medical treatment and medical billing, authorizing as appropriate based on Tristar claims Policies and Procedures.
  • Staff complex claims with supervisor to establish a plan of action and obtain settlement authority to commence settlement negotiations with Applicant Attorney.
  • Communicate with claimants, providers, and vendors regarding claims issues.
  • Maintain a diary system for case review and document file to reflect the status and work being performed on the file.
  • Compute and set reserves based on Tristar best practices with direction from supervisor.
  • Negotiate and/or finalize all claims based on settlement authority obtained from client with direction from supervisor.
  • Maintain a diary system for case review and document file to reflect the status and work being performed on the file.
  • Communicate appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety-related concerns with direction from supervisor.
Requirements
  • High school diploma or GED required; Bachelor's degree in related field (preferred); 2-3 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 people at all levels in the business environment.
  • Ability to effectively manage claims with high-level supervision.
  • Proficient in Word and Excel (preferred).
Benefits
  • Medical, Dental, and Vision Insurance
  • Life & Disability Insurance
  • 401(k) plan
  • Paid time off
  • Paid holidays
  • Referral Bonus

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