Workers Compensation Claims Examiner III

Job not on LinkedIn

🕒 August 6

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $70k - $85k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

TRISTAR Insurance Group

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1987

💼 Consulting

🏥 Healthcare

📦 Logistics

Consulting • Healthcare • Logistics

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

• Manage all aspects of indemnity workers’ compensation claims from inception to conclusion within established authority and guidelines • Manage a caseload of 150 or fewer workers’ compensation files, including complex claims • Initiate and investigate claims promptly • Determine claim compensability and administer benefits according to state law and company guidelines • Manage medical treatment and medical billing, authorizing as appropriate • Refer cases to outside defense counsel and direct/manage them as appropriate • Communicate with claimants, providers, and vendors regarding claims issues • Compute and set reserves within company guidelines • Settle and finalize claims and obtain designated authority • Maintain the diary system and document file status and work performed • Communicate relevant information to clients, including injury trends and safety concerns • Involve TRISTAR loss control staff when appropriate • Conduct file reviews independently • Adhere to company policies and procedures • Perform other duties as assigned

🎯 Requirements

• Bachelor’s degree in a related field preferred, or three (3) or more years of 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 conveying technical details to claimants, clients, and staff • Ability to interact with persons at all levels in the business environment • Ability to independently and effectively manage very complex claims • Proficiency in Microsoft Word and Excel preferred • Ability to perform light work, including lifting up to 20 pounds occasionally and up to 10 pounds frequently • Near, mid-range, and far vision required • Ability to talk and hear detailed information through verbal communication • Frequent repetitive wrist, hand, and finger motions • Appropriate office attire