Hybrid WC Claims Examiner III - Complex Claims Expert

Tristar Insurance; Phoenix (AZ); On-site; USD 75,000 - 85,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Plan

Paid Holidays

Paid Time Off

Referral bonus

Job summary

Tristar Insurance in Phoenix, AZ is seeking an experienced indemnity claims specialist to oversee all aspects of claim handling from inception to resolution. The role manages large workers’ compensation caseloads with emphasis on timely, compliant outcomes.

Responsibilities include initiating investigations, determining compensability, overseeing medical treatment and billing, and coordinating with defense counsel as needed to settle or finalize claims.

Qualifications

• Bachelor’s degree in related field; five (5) or more years related experience; or equivalent combination of education and experience.
• Technical knowledge of statutory regulations and medical terminology.
• Excellent written and verbal communication skills; ability to convey technical details to claimants, clients and staff.

Responsibilities

• Manages an average caseload of 130 workers’ compensation files, including very complex claims.
• Initiates and investigates in a timely manner.
• Determines compensability of claims and administers benefits according to state law and company guidelines.
• Develops and manages claims through action plans toward timely resolution.
• Manages medical treatment and medical billing, authorizing as appropriate.
• Calculates and pays benefits due and approves all claim payments.
• Refers cases to outside defense counsel and directs management as appropriate.
• Manages claim recoveries including deductible and subrogation.

Skills

Indemnity claims handling

Analytical skills

Communication skills

Excel

Self-insured claims

Education

Bachelor’s degree or higher

Tools

10-key

Fax machine

Copier

Printer

Computer

Job description

Tristar Insurance in Phoenix, AZ is seeking an experienced indemnity claims specialist to oversee all aspects of claim handling from inception to resolution. The role manages large workers’ compensation caseloads with emphasis on timely, compliant outcomes.

Responsibilities include initiating investigations, determining compensability, overseeing medical treatment and billing, and coordinating with defense counsel as needed to settle or finalize claims.