Lead Claims Examiner, Workers’ Compensation

Tristar Insurance; Fresno (CA); On-site; USD 77,000 - 94,000; 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 Fresno, CA is seeking an experienced claims professional to manage indemnity claims from inception to conclusion. The role requires extensive client interaction and collaboration with management and staff in the office.

The candidate will handle a large caseload, conduct timely investigations, determine claim compensability, manage medical treatment and billing, and coordinate with defense counsel as needed. Office-based position with day shift.

Qualifications

• Bachelor’s degree in related field preferred; and one (1) to five (5) years of related experience; or equivalent combination of education and experience.
• Knowledge of statutory regulations and medical terminology is expected.
• Excellent written and verbal communication skills and ability to convey technical details to claimants, clients and staff.

Responsibilities

• Manages a caseload of 150 to 180 workers’ compensation files, including complex claims.
• Initiates and conducts claims investigation in a timely manner.
• Determines compensability of claims and administers benefits according to state law and company guidelines.
• Manages medical treatment and medical billing, authorizing as appropriate.
• Refers cases to outside defense counsel and monitors legal aspects.
• Communicates with claimants, providers and vendors regarding claims issues.
• Computes and sets reserves within company guidelines.
• Settles and/or finalizes all claims and obtains authority as designated.
• Maintains diary system for case review and document file status.
• Communicates information promptly to the client to resolve claims efficiently.

Skills

Analytical skills

Communication skills

Client interaction

Claim management

Medical terminology

Word and Excel

Education

Bachelor’s degree in related field (preferred)

Job description

TRISTAR INSURANCE in Fresno, CA is seeking an experienced claims professional to manage indemnity claims from inception to conclusion. The role requires extensive client interaction and collaboration with management and staff in the office.

The candidate will handle a large caseload, conduct timely investigations, determine claim compensability, manage medical treatment and billing, and coordinate with defense counsel as needed. Office-based position with day shift.