Workers Compensation Claims Examiner III _ New York
Please make sure that you complete all of the questions, and information and sign your application at the end.
This is a Remote position or it can be a hybrid position if the adjuster lives in the Philadelphia area.
POSITION SUMMARY: Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.
This is a full-time position that requires considerable interaction with clients, claimants on the phone, and with management, other Claims Examiners, and other TRISTAR staff in the office; therefore consistently being at work in the office, in a timely manner, is inherently required of this position.
DUTIES AND RESPONSIBILITIES:
- Adjuster will work remotely from home
- Effectively manages a caseload of 100 to 125 workers’ compensation files, including very complex claims.*
- Jurisdiction is NY.*
- Initiates and conducts investigations in a timely manner.*
- Determines compensability of claims and administers benefits, based upon state law 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 sets reserves within Company guidelines. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II.*
- 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.*
- Involves TRISTAR loss control staff when appropriate.*
- Adheres to all Company policies and procedures.*
- Conduct file reviews independently.*
- Other duties as assigned.
* Essential job function.
EQUIPMENT OPERATED/USED: Computer, fax machine, copier, printer, and other office equipment.
SPECIAL EQUIPMENT OR CLOTHING: Appropriate business casual office attire