Senior Indemnity Claims Examiner – Complex & Litigated

TRISTAR RISK MANAGEMENT; Mather (CA); Presencial; USD 90.000 - 95.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, Dental, Vision Insurance

Life and Disability Insurance

401(k) Plan

Paid Holidays

Paid Time Off

Referral bonus

Descripción de la vacante

TRISTAR RISK MANAGEMENT in Sacramento, CA is seeking an experienced professional to manage complex indemnity claims from inception to resolution. You will work under the supervision of Claims leadership, handling very complex and litigated files, performing investigations, and determining compensability under state statutes and Best Practices.

The role requires strong analytical and communication skills, along with the ability to interact with clients, claimants, attorneys, and vendors.

Formación

• Technical knowledge of statutory regulations and medical terminology.
• Analytical skills demonstrated in handling complex claims.
• Excellent written and verbal communication to claimants, clients and staff.
• Ability to interact with people at all levels in the business environment.
• Ability to independently manage very complex claims.
• Proficient in Word and Excel (preferred).

Responsabilidades

• Manages a caseload of indemnity claim files, including complex and litigated claims.
• Initiates and conducts investigations in a timely manner.
• Determines compensability and administers benefits per state law and company practices.
• Manages medical treatment and medical billing; approves as appropriate.
• Refers cases to outside defense counsel and participates in litigated matters.
• Communicates with claimants, attorneys, providers, and vendors regarding claims issues.
• Maintains diary system and documents file status and plan of action.
• Communicates information promptly to clients to resolve claims efficiently.

Conocimientos

Regulatory knowledge

Analytical skills

Written and verbal communication

Interpersonal skills

Independent claims management

Microsoft Word

Microsoft Excel

Educación

Minimum five years related experience

Herramientas

Word

Excel

Descripción del empleo

TRISTAR RISK MANAGEMENT in Sacramento, CA is seeking an experienced professional to manage complex indemnity claims from inception to resolution. You will work under the supervision of Claims leadership, handling very complex and litigated files, performing investigations, and determining compensability under state statutes and Best Practices.

The role requires strong analytical and communication skills, along with the ability to interact with clients, claimants, attorneys, and vendors.