TRISTAR Insurance Group · 2 months ago
Workers Compensation Claims Examiner III _ New Jersey
Philadelphia, PA, USA
Full-time
Hybrid
Mid Level
$85K/yr - $92K/yr
3+ years expTRISTAR Insurance Group is seeking a Workers Compensation Claims Examiner III to manage all aspects of indemnity claims handling from inception to conclusion. This role involves considerable interaction with clients and requires effective management of a caseload of workers’ compensation files, including complex claims, while adhering to company guidelines.
Financial ServicesInsuranceRisk Management
Responsibilities
Effectively manages a caseload of 125 to 150 workers’ compensation files, including very complex claims.*
Jurisdiction is NJ.* (experience handling MD claims a plus)
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.*
Refers cases to outside defense counsel. Directs and manages as appropriate.*
Communicates with claimants, providers and vendors regarding claims issues.*
Computes and set reserves within Company guidelines. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II.*
Settles and/or finalize 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.*
Involves TRISTAR loss control staff when appropriate.*
Adheres to all Company policies and procedures.*
Conducts file reviews independently.*
Other duties as assigned
Qualification
Required
Bachelor's degree in related field (preferred); three (3) 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
Preferred
Proficient in Word and Excel (preferred)
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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