TRISTAR Insurance Group · 6 months ago
Workers Compensation Claims Examiner III
Houston, TX, USA
Full-time
Hybrid
Mid, Senior Level
$75K/yr - $83K/yr
5+ years expTRISTAR Insurance Group is a company specializing in insurance services, and they are seeking a Workers Compensation Claims Examiner III. This role involves managing all aspects of indemnity claims handling from inception to conclusion, requiring considerable interaction with clients and other staff to resolve claims efficiently.
Financial ServicesInsuranceRisk Management
Responsibilities
Effectively manages a caseload of 110 to 150 workers’ compensation files, including very complex claims.*
Initiates and conducts investigation in a timely manner.*
Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.*
Manages medical treatment and medical billing, authorizing as appropriate.*
Communicates with claimants, providers and vendors regarding claims issues.*
Computes and set reserves within Company guidelines
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 required
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
Proficient in Word and Excel (preferred)
Texas Workers Compensation License
Preferred
Bachelor's degree in related field
Proficient in Word and Excel
Benefits
Medical, Dental & Vision Insurance
Life & Disability Insurance
401(k) plan
Paid time off
Paid holidays.
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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