Workers Compensation Claims Examiner II (Remote)

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 on time is inherently required of this position.

DUTIES AND RESPONSIBILITIES:

• Effectively manages a caseload of 150 or fewer workers’ compensation files, including reasonably complex claims.
• Initiates and investigates promptly*
• Determines compensability of claims and administers benefits based upon state law and following established Company guidelines*
• Manages medical treatment and medical billing, authorizing as appropriate*
• Communicates with claimants, providers, and vendors regarding claims issues.
• Computes and sets reserves within Company guidelines.
• Maintains diary system for case review and documents file to reflect the status and work 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 as scheduled by the client and management.
• Other duties as assigned.
• Essential job function.

EQUIPMENT OPERATED/USED: Computer, 10-key, fax machine, copier, printer, and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire

QUALIFICATIONS REQUIRED:

Education/Experience: High school diploma or GED required; Bachelor’s degree in a related field (preferred); three (3) or more years of 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 conveying 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 fairly complex claims.
• Proficient in Word and Excel (preferred).

Other Qualifications:

None