Senior WC Claims Examiner - Hybrid, Complex Claims

Tristar-d43fac80; Phoenix (AZ); On-site; USD 65,000 - 95,000; Full time

Job summary

TRISTAR is seeking an experienced Claims Examiner to manage indemnity claims from inception to resolution under established guidelines. The role requires strong interaction with clients, claimants, and partners while handling a high-volume caseload of complex workers’ compensation files.

Responsibilities include initiating investigations, determining compensability, managing medical treatment and billing, calculating benefits, and finalizing settlements.

Qualifications

• Bachelor’s degree in related field preferred; five or more years of related experience or equivalent combination.
• Technical knowledge of statutory regulations and medical terminology.
• Analytical capabilities and strong written and verbal communication.

Responsibilities

• Manages an average caseload of ~130 workers’ compensation files, including complex claims.
• Initiates and investigates claims promptly and determines compensability.
• Develops action plans and manages medical treatment and billing; authorizes payments when appropriate.
• Calculates and pays benefits, sets reserves, and settles claims within guidelines.
• Refers cases to outside defense counsel as needed and manages subrogation and recoveries.

Skills

Indemnity claims handling

Analytics

Communication skills

Excel

Legal/regulatory knowledge

Education

Bachelor’s degree in related field

Tools

Word

Excel

Claims management software

Job description

TRISTAR is seeking an experienced Claims Examiner to manage indemnity claims from inception to resolution under established guidelines. The role requires strong interaction with clients, claimants, and partners while handling a high-volume caseload of complex workers’ compensation files.

Responsibilities include initiating investigations, determining compensability, managing medical treatment and billing, calculating benefits, and finalizing settlements.