Workers Compensation Claims Examiner I​/Medical

Overview

Houston Office - Houston, TX 77040 Position Type: Full Time,
Job Shift: Day,
Education Level: High School Diploma or GED,
Category: Admin - Clerical

Salary Range: $24.04 - $26.44 Hourly

Travel Percentage: None

Location: Houston Office - Houston, TX 77040

Under general supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.

Consistently required to be at work in the office, in a timely manner.

• Effectively manages a caseload of 150 to 180 workers’ compensation files, including complex claims.
• Initiates and conducts claims investigation in a timely manner.
• Determines compensability of claims and administers 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 as appropriate, monitors legal aspects.
• Communicates with claimants, providers and vendors regarding claims issues.
• Computes and sets reserves within Company guidelines.
• Settles and/or finalizes all claims and obtains authority as designated.
• Maintains diary system for case review and document file to reflect status and work being performed.
• 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.
• Participates in file reviews, as needed.
• Other duties as assigned.

Computer, 10-key, fax machine, copier, printer and other office equipment.

Appropriate office attire.

Preferred:
Bachelor’s degree in related field.

Required:

One to five 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).

• Certification and/or license as required by State regulation.

• Medical, Dental & Vision Insurance
• Life & Disability Insurance
• 401(k) plan
• Paid time off
• Paid holidays
• Referral bonus

Required to meet standard mental and physical requirements for this role, including reasonable accommodation available under policy and applicable law.