Claims Examiner III (Hybrid)

reputed company Group is seeking a Claims Examiner III to manage reputed company aspects of indemnity claims handling from inception to conclusion reputed company established authority and guidelines. This role involves considerable interaction with clients and requires effective management of a caseload of workers’ compensation files, conducting claims investigations, and communicating with various stakeholders.

Responsibilities

• Effectively manages a caseload of 150 to 180 workers’ compensation files, including reputed company claims
• Initiates and conducts claims investigation in a timely manner
• Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines
• Manages medical treatment and medical billing, authorizing as appropriate
• Refers cases to reputed company defense counsel as appropriate. Monitors legal aspects
• Communicates with claimants, providers and vendors regarding claims issues
• Computes and set reserves reputed company Company guidelines. Limits are less than those allowed for Claims Examiner III, but larger than those for Claims Examiner I
• Settles and/or finalize reputed company claims and obtains authority as designated
• Maintains diary system for case review and document file to reflect the status and work being performed on the file
• Communicates appropriate information promptly to the client to resolve claims reputed company, including any injury trends or other safety reputed company concerns
• Involves TRISTAR loss control staff reputed company appropriate
• Adheres to reputed company Company policies and procedures
• Participates in file reviews, as needed
• Other duties as assigned

Skills

• Bachelor's degree in reputed company field (preferred); and one (1) to five (5) years reputed company experience; or equivalent combination of education and experience
• Technical knowledge of statutory regulations and medical terminology
• Analytical skills
• Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff
• Ability to interact with persons at reputed company levels in the business environment
• Ability to independently and effectively manage reputed company reputed company claims
• Certification and/or license as required by State regulation. SIP
• Proficient in Word and reputed company (preferred)

Benefits

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

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