Workers Compensation Claims Examiner III

Tristar Insurance; Signal Hill (CA); On-site; USD 90,000 - 100,000; Full time

Benefits offered by this job

Medical, Dental and Vision Insurance

Life & Disability Insurance

401(K) Plan

Paid holiday

Paid time off

Referral bonus

Job summary

Tristar Insurance, located in Signal Hill, CA, is seeking an experienced claims manager to oversee all aspects of indemnity claims from inception to conclusion. The role requires managing a caseload of complex workers’ compensation files and conducting timely investigations.

Candidates should be analytical, possess excellent communication skills, and have a bachelor’s degree or equivalent experience. The company offers a comprehensive benefits package including medical, dental, vision, and a 401(K) plan.

Qualifications

• Education: Bachelor's degree in related field preferred.
• Three (3) or more years related experience required.
• Technical knowledge of statutory regulations and medical terminology necessary.

Responsibilities

• Manage a caseload of 150 to 180 workers’ compensation files.
• Initiate and conduct timely investigations.
• Determine compensability of claims and manage medical treatment.

Skills

Analytical skills

Excellent written and verbal communication

Technical knowledge of statutory regulations and medical terminology

Ability to manage complex claims

Proficiency in Word and Excel

Education

Bachelor’s degree in related field preferred

Three or more years related experience

Job description

Job Details: Level: Experienced | Job Location: Signal Hill Office - Signal Hill, CA 90755 | Position Type: Full Time | Education Level: High School Diploma or GED | Salary Range: $90,000.00 - $100,000.00 | Travel Percentage: None | Job Shift: Day | Job Category: Admin - Clerical

Position Summary: Under minimal supervision, manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. Requires extensive client interaction and consistent office presence.

Responsibilities

• Effectively manage a caseload of 150 to 180 workers’ compensation files, including very complex claims (essential).
• Initiate and conduct investigations in a timely manner (essential).
• Determine compensability of claims and administer benefits per state law and company guidelines (essential).
• Manage medical treatment and billing; authorize as appropriate (essential).
• Refer cases to outside defense counsel and direct management as appropriate (essential).
• Communicate with claimants, providers, and vendors regarding claim issues (essential).
• Compute and set reserves within company guidelines (essential).
• Settle/finalize all claims and obtain necessary authority (essential).
• Maintain diary system for case review and file documentation to reflect status (essential).
• Communicate relevant information promptly to the client to resolve claims efficiently, including injury trends or safety concerns.
• Adhere to all company policies and procedures.
• Conduct file reviews independently.
• Perform other duties as assigned.

Qualifications

• Education: Bachelor’s degree in related field preferred; three (3) or more years related experience; or equivalent combination of education and experience.
• Technical knowledge of statutory regulations and medical terminology.
• Analytical skills.
• Excellent written and verbal communication, including ability to convey technical details.
• Ability to interact with persons at all levels.
• Ability to independently and effectively manage complex claims.
• Proficiency in Word and Excel (preferred).
• Certifications/licenses as required by state regulation.

Benefits

• Medical, Dental and Vision Insurance
• Life & Disability Insurance
• 401(K) Plan
• Paid holiday
• Paid time off
• Referral bonus

Mental and Physical Requirements

See separate attachment for a checklist of mental and physical requirements. Key functions include:

• Mental effort: reasoning, mathematical, and language development tasks ranging from simple to complex problem solving.
• Physical effort: light work up to 20 lbs, light manipulations, medium to heavy tasks, lifting, gripping, standing, walking, reaching, pushing, pulling, and other specified movements.
• Vision requirements: far, near, mid-range, depth perception, color and field of vision.