Medical-Only Workers’ Comp Claims Examiner I

Tristar-d43fac80; Waukesha (WI); On-site; USD 50,000 - 75,000; Full time

Job summary

Tristar-d43fac80 seeks a detail-oriented Claims Examiner to manage medical-only workers’ compensation cases. You will interact with claimants, providers, and management while ensuring timely resolution and accurate medical billing approvals.

Strong communication and analytical skills are essential to interpret state laws and company policies. Responsibilities include initiating contact, determining compensability, and maintaining accurate case diaries and reserves, with a focus on efficient

Qualifications

• High school diploma or GED required; bachelor’s degree preferred.
• Experience with workers’ comp claims or related insurance work is valued.
• Strong written and verbal communication; able to explain complex details clearly.

Responsibilities

• Manages an assigned medical-only workers’ compensation caseload from start to finish.
• Initiates prompt 3-point contact with clients and TRISTAR staff per guidelines.
• Determines claim compensability and administers benefits per state law.
• Manages medical treatment and billing approvals as appropriate.
• Refer cases to Indemnity Examiner when conversion criteria are met.
• Communicates with claimants, providers, and vendors on issues.
• Calculates and records reserves within company guidelines up to 10,000.
• Maintains diary and file status; tracks work performed and deadlines.

Skills

Claim evaluation

Client communication

Analytical reasoning

Verbal/written comms

Education

High School Diploma or GED

Bachelor’s degree (preferred)

Tools

MS Word

MS Excel

Claims software

Job description

Tristar-d43fac80 seeks a detail-oriented Claims Examiner to manage medical-only workers’ compensation cases. You will interact with claimants, providers, and management while ensuring timely resolution and accurate medical billing approvals.

Strong communication and analytical skills are essential to interpret state laws and company policies. Responsibilities include initiating contact, determining compensability, and maintaining accurate case diaries and reserves, with a focus on efficient