Workers Compensation Claims Examiner III CorpusChristi Hybrid
Workers Compensation Claims Examiner III CorpusChristi Hybrid
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Job Description
Job Details
Workers Compensation Claims Examiner III (HYBRID)
THIS POSITION CAN BE HYBRID. PLEASE SIGN THE APPLICATION AT THE END.
POSITION SUMMARY: Under minimal 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 150180 workers compensation files including very complex claims.*
- Initiates and conducts investigations in a timely manner.*
- Determines compensability of claims and administers benefits based upon state law and in accordance with established Company guidelines.*
- Manages medical treatment and medical billing authorizing as appropriate.*
- Communicate with claimants providers and vendors regarding claims issues.
- Computes and sets reserves within Company guidelines. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II with changes authorized up to $1000000.
- 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 safetyrelated concerns.*
- Involves TRISTAR loss control staff when appropriate.
- Adheres to all Company policies and procedures.*
- Other duties as assigned.
* Essential job function.
EQUIPMENT OPERATED/USED: Computer 10key fax machine copier printer and other office equipment.
SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire
Qualifications
QUALIFICATIONS REQUIRED:
Education/Experience: High School Diploma or GED required. Bachelors degree in a related field (preferred); five 5 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 the 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
Here are some of the benefits you can enjoy in this role:
- Medical Dental Vision Disability & Life Insurance
- 401(k) Plan
- Paid time off
- Paid holidays
- Referral bonus
Required Experience:
Senior IC
Employment Type
Full-Time
