TRISTAR Insurance Group · 2 months ago
Workers Compensation Claims Examiner III
Kapolei, HI, USA
Full-time
Onsite
Mid Level
$70K/yr - $85K/yr
3+ years expTRISTAR Insurance Group is seeking a Workers Compensation Claims Examiner III to manage all aspects of indemnity and future medical claims from inception to conclusion. The role involves considerable interaction with clients, claimants, medical providers, and vendors, ensuring efficient claims resolution and adherence to company guidelines.
Financial ServicesInsuranceRisk Management
Responsibilities
Effectively manages a caseload of 130 to 150 workers’ compensation files, including complex claims
Initiates and conducts investigation in a timely manner
Determines compensability of claims and administer benefits, based upon state laws/Rules 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/Client guidelines
Settles and/or finalizes 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
Adheres to all Company policies and procedures
Conducts file reviews
Adheres to agreed client handling instructions
Other duties as assigned
Essential job function
Qualification
Required
three (3) or more years related 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
Certifications and/or licenses as required by State regulation
Preferred
Bachelor's degree in related field
Proficient in Word and Excel
Benefits
Medical, Dental, Vision, Disability and Life 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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