Workers Compensation Claims Examiner

Overview

Signal Hill Office - Signal Hill, CA 90755

Salary Range
: $24.00 - $30.00 Hourly

Position Type
:
Full Time |
Job Shift
:
Day |
Education Level
:
High School Diploma or GED |
Travel Percentage
:
None |
Category
:
Insurance |
Workers Compensation Claims Examiner I

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

This hybrid position requires consistent presence at the office in Signal Hill, CA.

• Effectively manages a caseload of indemnity workers’ compensation files with supervision.
• Initiates and conducts investigations in a timely manner based upon state law and TRISTAR best practices.
• Determines compensability of claims and administers benefits, in accordance with company guidelines.
• Manages medical treatment and billing, authorizing as appropriate based on TRISTAR claims policies.
• Staffs complex claims with supervisor to establish plan of action and obtain settlement authority to commence settlement negotiations with applicant attorney.
• Communicates with claimants, providers, and vendors regarding claims issues.
• Maintains diary system for case review and document file to reflect status and work being performed.
• Computes and sets reserves based upon TRISTAR best practices with direction from supervisor.
• Negotiates and/or finalizes all claims based on settlement authority obtained from client with direction from supervisor.
• Adheres to all TRISTAR company policies and procedures.
• Conducts ongoing file reviews with supervisor for development.
• Other duties as assigned by supervisor.

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

• Education/Experience
  :
  High school diploma or GED required;
  Bachelor’s degree in related field (preferred); 2-3 years 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;
  Ability to interact with people at all levels;
  Ability to effectively manage claims with high level of supervision;
  Proficient in Word and Excel (preferred).

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

Equal Employment Opportunity:
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or any other protected status.