Workers Compensation Claims Examiner ; Medical Claims Temporary

Position: Workers Compensation Claims Examiner I (Medical Only Claims) Temporary to Hire

Phoenix Office - Phoenix, AZ 85014

Overview

Salary Range: $20.00 - $20.00 Hourly Position Type:
Temporary

Job Shift:
Day Education Level:
High School Diploma or GED

Travel Percentage :
Negligible Category:
Insurance Workers Compensation Claims Examiner I (Medical Only Claims)

POSITION SUMMARY: Under close supervision manages all aspects of medical only claims handling from inception to conclusion within established authority and guidelines.

This position requires considerable interaction with clients, claimants on the phone, and with management, other Claims Examiners, and other TRISTAR staff in the office; therefore consistently being at work in the office, in a timely manner, is inherently required of this position.

(Hybrid in/out of office, depending on requirements for the office)

Duties and Responsibilities

• Effectively manages an assigned caseload of workers compensation claim.
• Initiates and conducts claims 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.
• Communicates with claimants, providers and vendors regarding claims issues.
• Computes and set reserves within Company guidelines.
• Maintains diary system for case review and document file to reflect the status of 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.
• Adheres to all TRISTAR company policies and procedures.
• Participates in file reviews, as needed.
• Other duties as assigned and including claims management of other jurisdictional workers’ comp claims.

* Essential job function.

Equipment Operated/Used

Computer, fax machine, copier, printer and other office equipment.

Special Equipment or Clothing

Appropriate office attire

Qualifications Education/Experience

Minimum of two (2) year related experience; or equivalent combination of education and experience.

Knowledge,

Skills and Abilities

• 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.
• Proficient in Word and Excel (preferred).

Other Qualifications

Arizona Adjuster’s License (preferred).

Mental and

Physical Requirements 1. MENTAL EFFORT

a. Reasoning development::

Follow one- or two-step instructions; routine, repetitive task.

Carry out detail but uninvolved written or verbal instructions; deal with a few concrete

variables.

Follow written, verbal, or diagrammatic instructions; several concrete variables.

X Solve practical problems; variety of variables with limited standardization; interpret instructions.

Logical or scientific thinking to solve problems; several abstract and concrete variables.

Wide range of intellectual and practical problems; comprehend most obscure concepts.

b. Mathematical development:

X Simple additional and subtraction; copying figures, counting, and recording.

X Add, subtract, multiply, and divide whole numbers.

X Arithmetic calculations involving fractions, decimals, and percentages.

Arithmetic, algebraic, and geometric calculations.

Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.

Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application.

c. Language development:

Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.

Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.

Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work…