Worker Compensation Claims Examiner III

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🔥 18 hours ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $60k - $75k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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TRISTAR Insurance Group

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1987

🤝 B2B

⚕️ Healthcare Insurance

B2B • Healthcare Insurance

TRISTAR Insurance Group is a national third-party administrator (TPA) that provides insurance administration and risk management services to employers, insurers and public entities. Its solutions include property & casualty, workers' compensation, general and auto liability, managed care (bill review, case management, utilization review, nurse triage, pharmacy benefit management), absence and disability management, employee group benefits administration, and risk control and workplace safety services. TRISTAR emphasizes collaborative, technology-enabled and tailored services to transform risk into opportunity for its clients.

📋 Description

• Manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines • Effectively manages a caseload of 150 workers’ compensation files • Initiates and conducts investigations in a timely manner • Determines compensability of claims and administers benefits • Manages medical treatment and billing • Refers cases to outside defense counsel and directs as appropriate • Communicates with claimants, providers and vendors regarding claims issues • Computes and sets reserves within Company guidelines • Settles and/or finalizes all claims • Maintains diary system for case review and documents file status • Communicates appropriate information promptly to the client

🎯 Requirements

• Bachelor’s degree in related field (preferred) • Three (3) or more years related experience • Technical knowledge of statutory regulations and medical terminology • Analytical skills • Excellent written and verbal communication skills • Ability to independently and effectively manage very complex claims • Proficient in Word and Excel (preferred) • Texas Workers Compensation License

🏖️ Benefits

• Medical, Dental, Vision Insurance • Life and Disability Insurance • 401(k) Plan • Paid Holidays • Paid Time Off • Referral bonus