Senior Workers' Comp Claims Examiner

Tristar Insurance; Mather (CA); On-site; USD 90,000 - 95,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k)

Paid Time Off

Paid Holidays

Referral Bonus

Job summary

Tristar Insurance seeks an experienced claims professional to manage complex indemnity claims from inception to conclusion. You will oversee investigations, assess compensability, and coordinate medical treatment and billing in coordination with state regulations and company practices.

The role requires handling litigated files, liaising with claimants, attorneys, providers, and vendors, and maintaining reserves and action plans to resolve claims efficiently.

Qualifications

• Minimum five (5) years related experience or equivalent combination of education and experience.
• Licenses as required by Jurisdiction.
• Technical knowledge of statutory regulations and medical terminology.
• Excellent written and verbal communication skills with ability to convey technical details.
• Ability to independently manage very complex claims.
• Proficient in Word and Excel (preferred).

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 per state law and best practices.
• Manages medical treatment and medical billing; authorizes as appropriate.
• References cases to outside defense counsel and participates in litigated matters.
• Communicates with claimants, attorneys, providers, and vendors regarding claims issues.
• Computes and sets reserves within company guidelines.
• Maintains diary system and provides status updates with action plans.

Skills

Regulatory knowledge

Analytical skills

Communication skills

Interpersonal skills

Complex claims management

MS Word/Excel

Tools

Word

Excel

Job description

Tristar Insurance seeks an experienced claims professional to manage complex indemnity claims from inception to conclusion. You will oversee investigations, assess compensability, and coordinate medical treatment and billing in coordination with state regulations and company practices.

The role requires handling litigated files, liaising with claimants, attorneys, providers, and vendors, and maintaining reserves and action plans to resolve claims efficiently.