Workers Compensation Claims Examiner II

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🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $50k - $70k / 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

• Effectively manages a caseload of 150 or fewer workers’ compensation files • Initiates and investigates promptly • Determines compensability of claims and administers benefits based upon state law • 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 diary system for case review • Communicates appropriate information promptly to the client to resolve claims efficiently • Adheres to all Company policies and procedures • Conducts file reviews as scheduled by the client and management

🎯 Requirements

• High school diploma or GED required • Bachelor’s degree in a related field (preferred) • Three (3) or more years of related experience • Technical knowledge of statutory regulations and medical terminology • Analytical skills • Excellent written and verbal communication skills • Ability to interact with persons at all levels in the business environment • Ability to independently and effectively manage fairly complex claims • Proficient in Word and Excel (preferred)

🏖️ Benefits

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