Workers Compensation Claims Examiner III

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🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $70k - $85k / 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, including complex claims. • Initiates and investigates promptly. • Determines compensability of claims and administers benefits based upon state law and following established Company guidelines. • Manages medical treatment and medical billing, authorizing as appropriate. • Refers cases to outside defense counsel. Directs and manages as appropriate. • Communicates with claimants, providers, and vendors regarding claims issues. • Computes and sets reserves within Company guidelines. • Settles and finalizes all claims and obtains authority as designated. • Maintains diary system for case review and documents file to reflect the status and work 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. • Conducts file reviews independently.

🎯 Requirements

• Bachelor’s degree in a related field (preferred) • Three (3) or more years of related experience; or equivalent combination of education and experience. • WC Adjuster’s license for MI & MN preferred but will also consider an adjuster's license for TX, FL & Indiana • 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 independently and effectively manage very complex claims. • Proficient in Word and Excel (preferred).

🏖️ Benefits

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