Senior Workers' Comp Claims Examiner

TRISTAR RISK MANAGEMENT; Corpus Christi (TX); On-site; USD 60,000 - 75,000; 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 seeks an experienced claims professional to manage indemnity claims from inception to conclusion. The role requires substantial client and staff interaction and adherence to state regulations.

The position focuses on complex workers’ compensation claims, medical billing oversight, and timely investigations, with authority to settle after proper review.

Qualifications

• Bachelor’s degree in a related field with 3+ years of related experience or equivalent.
• Statutory regulations and medical terminology knowledge.
• Excellent written and verbal communication skills.
• Ability to independently manage very complex claims.
• Proficiency in Word and Excel.

Responsibilities

• Manages a caseload of 150 workers’ compensation files, including very complex claims.
• Initiates and conducts investigations in a timely manner.
• Determines compensability of claims and administers benefits according to state law and company guidelines.
• Manages medical treatment and medical billing, authorizing as appropriate.
• Refers cases to outside defense counsel and manages as appropriate.
• Communicates with claimants, providers, and vendors regarding claims issues.
• Computes and sets reserves within company guidelines.

Skills

Analytical

Written and verbal communication

MS Word

MS Excel

Client interaction

Education

Bachelor's degree in related field

3+ years of related experience

Job description

TRISTAR RISK MANAGEMENT in Corpus Christi, TX seeks an experienced claims professional to manage indemnity claims from inception to conclusion. The role requires substantial client and staff interaction and adherence to state regulations.

The position focuses on complex workers’ compensation claims, medical billing oversight, and timely investigations, with authority to settle after proper review.