Medical Claims Examiner I (Workers' Comp)

TRISTAR RISK MANAGEMENT; Corpus Christi (TX); On-site; USD 28,000 - 40,000; 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 RISK MANAGEMENT in Corpus Christi, TX is seeking an experienced Medical Claims Examiner to manage a full caseload of workers’ compensation files from inception to resolution under established guidelines. The role requires strong communication with claimants, providers, and clients, plus solid knowledge of medical terminology and statutory regulations.

A minimum of one year of related experience is required. Proficiency with Word and Excel is preferred.

Qualifications

• Knowledge of statutory regulations and medical terminology.
• Analytical skills to review complex information.
• Excellent written and verbal communication with claimants, clients and staff.
• Ability to interact effectively with colleagues at all levels.

Responsibilities

• Manage a caseload of 150 to 180 workers’ compensation files.
• Initiate and conduct timely claims investigations.
• Determine compensability and administer benefits per state law and guidelines.
• Manage medical treatment and medical billing.
• Communicate with claimants, providers and vendors.
• Compute and set reserves within guidelines.
• Maintain diary system for case review and status updates.
• Provide information to clients to resolve claims efficiently.

Skills

Medical terminology

Claims handling

Analytical skills

Communication skills

Word processing

Excel

10-key

Tools

Word

Excel

10-key

Fax machine

Job description

TRISTAR RISK MANAGEMENT in Corpus Christi, TX is seeking an experienced Medical Claims Examiner to manage a full caseload of workers’ compensation files from inception to resolution under established guidelines. The role requires strong communication with claimants, providers, and clients, plus solid knowledge of medical terminology and statutory regulations.

A minimum of one year of related experience is required. Proficiency with Word and Excel is preferred.