Workers Compensation Claims Examiner II

Tristar Insurance; West Allis (WI); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Medical, Dental and Vision insurance

Life & Disability insurance

401(k) plan

Paid holidays

Paid time off

Referral bonus

Job summary

Tristar Insurance is seeking a claims manager in West Allis, Wisconsin to manage indemnity claims from start to finish. The ideal candidate should have a high school diploma or GED, with a preference for a Bachelor’s degree, and at least three years of experience in claims management.

As a claims manager, you'll be responsible for a caseload of fewer than 150 workers’ compensation files, including initiating claims and determining compensability. Benefits include medical, dental, and vision insurance, along with a 401(k) plan.

Qualifications

• High school diploma or GED required.
• Bachelor’s degree in related field preferred.
• Three or more years of related experience required.

Responsibilities

• Manage a caseload of 150 or fewer workers’ compensation files.
• Initiate and investigate claims promptly.
• Determine compensability of claims.

Skills

Technical knowledge of statutory regulations and medical terminology

Analytical skills

Excellent written and verbal communication skills

Ability to interact with persons at all levels

Ability to independently manage complex claims

Proficiency in Word and Excel

Education

High school diploma or GED

Bachelor’s degree in a related field

3+ years of related experience

Job description

Position Summary

Under general supervision, manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.

Duties and Responsibilities

• Effectively manage a caseload of 150 or fewer workers’ compensation files, including reasonably complex claims.
• Initiate and investigate claims promptly.
• Determine compensability of claims and administer benefits based upon state law and company guidelines.
• Manage medical treatment and billing, authorizing as appropriate.
• Communicate with claimants, providers, and vendors regarding claim issues.
• Compute and set reserves within company guidelines.
• Maintain diary system for case review and document file status.
• Communicate relevant information promptly to the client to resolve claims efficiently, including injury trends or safety-related concerns.
• Adhere to all company policies and procedures.
• Conduct file reviews as scheduled by the client and management.
• Other duties as assigned.

Essential job function.

Equipment Operated/Used

Computer, 10‑key, fax machine, copier, printer, and other office equipment.

Special Equipment or Clothing

Appropriate office attire.

Qualifications Required

Education/Experience: High school diploma or GED required; Bachelor’s degree in a related field (preferred); three (3) or more years of related experience; or equivalent combination of education and experience.

Knowledge, Skills, and Abilities

• Technical knowledge of statutory regulations and medical terminology.
• Analytical skills.
• Excellent written and verbal communication skills, including conveying technical details to claimants, clients, and staff.
• Ability to interact with persons at all levels in the business environment.
• Ability to independently and effectively manage fairly complex claims.
• Proficiency in Word and Excel (preferred).

Other Qualifications

None.

Benefits

• Medical, Dental and Vision insurance
• Life & Disability insurance
• 401(k) plan
• Paid holidays
• Paid time off
• Referral bonus

Mental and Physical Requirements

Refer to the attached checklist for detailed mental and physical capability requirements.