Claims Examiner III (Hybrid)

Claims Examiner III (Hybrid): Manage complex and litigated indemnity claims from inception to conclusion, interacting with clients, claimants, medical providers, attorneys, and other staff. Conduct investigations, determine compensability, administer benefits, and communicate with stakeholders.

Requirements

• Effectively manage a caseload of indemnity claim files
• Initiate and conduct investigations in a timely manner
• Determine compensability of claims and administer benefits based on state law and TRISTAR Best Practices
• Manage medical treatment and medical billing, authorizing as appropriate
• Refer cases to outside defense counsel and participate in litigated matters
• Communicate with claimants, attorneys, providers, and vendors regarding claims issues
• Work in an organized and proactive manner
• Compute and set reserves within Company guidelines
• Settle and/or finalize all claims and obtain authority as designated
• Maintain a diary system for case review and documents file to reflect the status and work being performed on the file, including a plan of action
• Communicate appropriate information promptly to the client to resolve claims efficiently
• Conduct file reviews as scheduled by the client and management
• Identify and review claims for the Apportionment assignment
• Identify and investigate subrogation potential and pursue recovery
• Identify claim standard criteria for excess reporting and reimbursement
• Assist with State Audit and reporting responses
• Mentor less experienced Examiners

Benefits

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