Workers Compensation Claims Examiner II

This is a Hybrid position with the potential to be remote.

POSITION SUMMARY: At the Direction of the Claims Supervisor, manages all aspects of indemnity and future medical claims from inception to conclusion within established authority and guidelines. This position requires considerable interaction with clients, claimants, Medical providers, Vendors, and other TRISTAR staff in the office.

DUTIES AND RESPONSIBILITIES:

· Effectively manages a caseload of 130 to 150 workers’ compensation files, including

complex claims.

· Initiates and conducts investigation in a timely manner.

· Determines compensability of claims and administer benefits, based upon state

laws/Rules and in accordance with 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 set reserves within Company/Client 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.

· Communicates appropriate information promptly to the client to resolve claims efficiently

,including any injury trends or other safety related concerns.

· Adheres to all Company policies and procedures.

· Conducts file reviews

· Adheres to agreed client handling instructions

· Other duties as assigned.

· Essential job function

EQUIPMENT OPERATED/USED: Computer, 10-key, fax machine, copier, printer, phone, and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire.