Claims Examiner I – Medical Only Adjuster Experience

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🤠 Texas – Remote

🤠 Texas – Remote

💵 $40k - $50k / year

⏰ Full Time

🟢 Junior

📋 Claims Specialist

🚫👨‍🎓 No degree required

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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

• Effectively manages a caseload of 150 to 180 workers’ compensation files. • 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. • Communicates with claimants, providers, and vendors regarding claims issues. • Computes and sets reserves within Company guidelines. • Maintains a diary system for case review and document file to reflect the status of and work being performed on the file. • 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.

🎯 Requirements

• Minimum of one (1) year 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. • Proficient in Word and Excel (preferred).

🏖️ Benefits

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