Workers Compensation Claims Examiner III

The Workers Compensation Claims Examiner III manages all aspects of complex and litigated indemnity claims from inception to conclusion. This is a hybrid position with the potential to be remote, requiring considerable interaction with clients, claimants, medical providers, attorneys, vendors, and other staff.

Requirements

• Effectively manages a caseload of indemnity claim files, including complex and litigated claims.
• Initiates and conducts investigation in a timely manner.
• Determines compensability of claims and administers benefits based upon state law and TRISTAR Best Practices for claim handling.
• Manages medical treatment and medical billing, authorizing as appropriate.
• Refers cases to outside defense counsel and participates in litigated matters.
• Communicates with claimants, attorneys, providers, and vendors regarding claims issues.
• Works in an organized and proactive manner.
• Computes and sets reserves within Company guidelines.
• Settles and/or finalizes all claims and obtains authority as designated.
• Maintains diary system for case review and documents file to reflect the status and work being performed on the file, including a plan of action.
• Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety-related concerns.
• Conducts file reviews as scheduled by the client and management.
• Identifies and reviews claims for Apportionment assignment.
• Identifies and investigates subrogation potential and pursues recovery.
• Identifies claim standard criteria for excess reporting and reimbursement.
• Assists with State Audit and reporting responses.
• Mentors less experienced Examiners.
• Performs other duties as assigned, including claims management of other jurisdictional workers' comp claims.

Benefits

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