Senior Indemnity Claims Examiner – Complex/Litigated (Hybrid)

Tristar Insurance; Rancho Cordova (CA); Hybrid; USD 85,000 - 95,000; 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 Sacramento/ Rancho Cordova, CA seeks an experienced claims professional to manage complex indemnity claims from inception to conclusion under supervision. This hybrid, temp-to-hire role requires coordinating with claimants, attorneys, medical providers, vendors and TRISTAR staff; perform investigations, reserve setting and determinations of compensability.

Strong knowledge of state regulations and medical terminology, plus proficiency in Word and Excel, and excellent written

Qualifications

• Minimum five years of related experience.
• Knowledge of statutory regulations and medical terminology.
• Excellent written and verbal communication skills.
• Ability to independently manage very complex claims.
• Licenses as required by jurisdiction.

Responsibilities

• Manages a caseload of indemnity claim files, including complex and litigated claims.
• Initiates and conducts investigations in a timely manner.
• Determines compensability of claims and administers benefits.
• Manages medical treatment and medical billing, authorizing as appropriate.
• Refers cases to outside defense counsel and participates in litigated matters.
• Communicates with claimants, attorneys, providers and vendors.
• Computes and sets reserves within Company guidelines.
• Settles and/or finalizes all claims and obtains authority as designated.
• Mentors less experienced Examiners.
• Handles multi-jurisdictional claims as assigned.

Skills

Indemnity claims experience

Complex claims management

Analytical skills

Communication skills

Litigation coordination

Tools

Microsoft Word

Microsoft Excel

Job description

Tristar Insurance in Sacramento/ Rancho Cordova, CA seeks an experienced claims professional to manage complex indemnity claims from inception to conclusion under supervision. This hybrid, temp-to-hire role requires coordinating with claimants, attorneys, medical providers, vendors and TRISTAR staff; perform investigations, reserve setting and determinations of compensability.

Strong knowledge of state regulations and medical terminology, plus proficiency in Word and Excel, and excellent written