WC Medical Claims Examiner I

Tristar Insurance; Milwaukee, Waukesha (WI, WI); In loco; USD 26.000 - 33.000; Tempo pieno

Descrizione del lavoro

TRISTAR Insurance seeks an experienced claims professional to manage medical-only workers’ compensation cases in Milwaukee. You will interact with claimants, providers, and clients to assess, authorize, and resolve claims within regulatory guidelines.

The role requires attention to detail, timely communication, and accurate billing management. A high school diploma or GED is required, with a preference for a bachelor’s degree and active adjuster license where applicable.

Competenze

• High School Diploma or GED required; Bachelor’s degree preferred; 1+ year related experience.
• Active adjuster’s license in IN, MN, or MI or reciprocity state.
• Technical understanding of medical terminology and regulations.
• Excellent written and verbal communication skills.
• Proficient in Word and Excel.

Mansioni

• Manages a medical-only caseload of workers’ compensation claims.
• Initiates 3-point contact promptly per Client and TRISTAR.
• Determines compensability and administers benefits per state law and guidelines.
• Manages medical treatment and medical billing; authorize as appropriate.
• Communicates with claimants, providers, and vendors regarding claims issues.
• Maintains diary system and case file status; updates client.
• Calculates reserves within policy limits and escalates when needed.

Conoscenze

Client interaction

Communication

Medical terminology

Analytical thinking

Computer literacy

Formazione

High School Diploma or GED

Bachelor’s degree (preferred)

Strumenti

Word

Excel

Descrizione del lavoro

TRISTAR Insurance seeks an experienced claims professional to manage medical-only workers’ compensation cases in Milwaukee. You will interact with claimants, providers, and clients to assess, authorize, and resolve claims within regulatory guidelines.

The role requires attention to detail, timely communication, and accurate billing management. A high school diploma or GED is required, with a preference for a bachelor’s degree and active adjuster license where applicable.