Worker Compensation Claims Examiner III (Hybrid)

Tristar Insurance; Albuquerque (NM); On-site; USD 70,000 - 85,000; Full time

Benefits offered by this job

Medical, Dental, Vision Insurance

Life and Disability Insurance

401(k) Plan

Paid Holidays

Paid Time Off

Referral bonus

Job summary

Tristar Insurance in Albuquerque seeks an experienced claims manager to handle indemnity claims from inception to conclusion. This full-time position requires managing a caseload of approximately 130 workers’ compensation files and interacting with clients and claimants.

The ideal candidate should have a bachelor's degree or 5+ years of experience, strong analytical skills, and excellent communication abilities.

Benefits include medical, dental, vision insurance, and a 401(k) plan.

Qualifications

• Education: Bachelor’s degree in a related field or 5+ years of experience.
• Technical knowledge of statutory regulations and medical terminology.
• Ability to interact with persons at all levels in the business environment.

Responsibilities

• Manage caseload of 130 workers’ compensation files.
• Conduct investigations and determine compensability of claims.
• Communicate issues with clients, claimants, providers, and vendors.

Skills

Analytical skills

Excellent written and verbal communication

Ability to manage complex claims

Proficiency in Word and Excel

Knowledge of statutory regulations

Education

Bachelor's degree in a related field

5+ years of related experience

Tools

Computer

10-key

fax machine

copier

printer

Job description

Job Details: Level: Experienced | Location: Albuquerque Office - Albuquerque, NM 87110 | Position Type: Full Time | Salary Range: $70,000.00 - $85,000.00 | Shift: Day | Category: Insurance. (Hybrid, temp-to-hire opportunity)

Position Summary

Under minimal supervision, manage all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.

Duties and Responsibilities

• Effectively manage an average caseload of 130 workers’ compensation files, including very complex claims.
• Initiate and conduct investigations in a timely manner.
• Determine compensability of claims and administer benefits based upon state law and company guidelines.
• Develop and manage claims through well-developed action plans to bring the claim to a timely resolution.
• Manage medical treatment and billing, authorizing as appropriate.
• Calculate and pay benefits due; approve all claim payments.
• Refer cases to outside defense counsel and direct as appropriate.
• Manage claim recoveries of all types, including deductible and subrogation.
• Communicate with clients, claimants, providers and vendors regarding claim issues.
• Compute and set reserves within company guidelines.
• Settle or finalize all claims and obtain designated authority.
• Maintain diary system for case review and document file status.
• Communicate relevant information promptly to clients to resolve claims efficiently, including injury trends or safety concerns.
• Adhere to all company policies and procedures.
• Conduct file reviews independently.
• Perform other duties as assigned.

Equipment Operated/Used

• Computer, 10-key, fax machine, copier, printer, and other office equipment.

Qualifications

• Education: Bachelor’s degree in a related field (preferred) or five (5) or more years of related experience, or an equivalent combination of education and experience.
• Technical knowledge of statutory regulations and medical terminology.
• Analytical skills.
• Excellent written and verbal communication skills, including the ability to convey technical details to claimants, clients, and staff.
• Ability to interact with persons at all levels in the business environment.
• Ability to independently and effectively manage very complex claims.
• Proficiency in Word and Excel (preferred).
• Knowledge of self-insured claims handling (preferred).
• City, county, and/or district claims handling experience (preferred).
• Certifications and/or licenses as required by state regulation.

Benefits

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