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TRISTAR Insurance Group · 3 months ago

Workers Compensation Claims Examiner III

Waukesha, WI, USA

Full-time

Hybrid

Mid Level

$70K/yr - $85K/yr

3+ years exp

TRISTAR Insurance Group is seeking a Workers Compensation Claims Examiner III to manage all aspects of indemnity claims handling from inception to conclusion. The role involves considerable interaction with clients and requires effective management of a caseload of workers’ compensation files, ensuring compliance with state laws and company guidelines.

Financial ServicesInsuranceRisk Management

Responsibilities

Effectively manages a caseload of 150 or fewer workers’ compensation files, including 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.*

Refers cases to outside defense counsel. Directs and manages as appropriate.*

Communicates with claimants, providers, and vendors regarding claims issues.*

Computes and sets reserves within Company guidelines. Limits are more significant than those allowed for Claims Examiner I and Claims Examiner II.*

Settles and finalizes all claims and obtains authority as designated.*

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.*

Involves TRISTAR loss control staff when appropriate.*

Adheres to all Company policies and procedures.*

Conducts file reviews independently.*

Other duties as assigned.*

Qualification

WC Adjuster's licenseStatutory regulations knowledgeMedical terminology knowledgeAnalytical skillsManage complex claimsWritten communication skillsVerbal communication skillsProficient in WordProficient in ExcelInterpersonal skills

Required

Bachelor's degree in a related field (preferred); three (3) or more years of related experience; or equivalent combination of education and experience

WC Adjuster's license for MI & MN preferred but will also consider an adjuster's license for TX, FL & Indiana

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 very complex claims