TRISTAR Insurance Group · 1 month ago
Claims Examiner III (Hybrid)
Sacramento - Rancho Cordova, CA 95670
Full-time
Hybrid
Mid, Senior Level
$90K/yr - $95K/yr
5+ years expTRISTAR Insurance Group is seeking a Claims Examiner III to manage complex and litigated indemnity claims. The role involves considerable interaction with clients, claimants, and various stakeholders, ensuring claims are handled efficiently and in accordance with company policies.
Financial ServicesInsuranceRisk Management
Responsibilities
Effectively manages a caseload of indemnity claim files, including very complex and litigated claims
Initiates and conducts investigations in a timely manner
Determines compensability of claims and administers benefits based upon state law and TRISTAR Best Practices for claim handling
Manages medical treatment and medical billing, authorizing as appropriate
Refers cases to outside defense counsel and participates in litigated matters
Communicates with claimants, attorneys, providers, and vendors regarding claims issues
Work in an organized and proactive manner
Computes and sets reserves within Company guidelines
Settles and/or finalizes all claims and obtains authority as designated
Maintains a diary system for case review and documents file to reflect the status and work being performed on the file, including a plan of action
Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety-related concerns
Conducts file reviews as scheduled by the client and management
Identify and review claims for the Apportionment assignment
Identify and investigate subrogation potential and pursue recovery
Identify claim standard criteria for excess reporting and reimbursement
Assist with State Audit and reporting responses
Mentors less experienced Examiners
Other duties as assigned and including claims management of other jurisdictional workers’ comp claims
Adheres to all TRISTAR company policies and procedures
Qualification
Required
Minimum 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 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
Licenses as required by the Jurisdiction
Preferred
Proficient in Word and Excel
Benefits
Medical, Dental, Vision Insurance.
Life and Disability Insurance.
401(k) Plan
Paid Holidays
Paid Time Off.
Referral bonus.
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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