Workers Compensation Claims Examiner III _ Temp

Tristar Insurance; Chino Hills (CA); Presencial; USD 70 000 - 90 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical, Dental & Vision Insurance

Life & Disability Insurance

401(k) plan

Paid time off

Paid holidays

Referral bonus

Resumo da oferta

Tristar Insurance in Chino Hills seeks a Claims Manager to oversee all aspects of indemnity claims handling. You will manage a caseload of 150 to 180 complex workers' compensation files and communicate effectively with various stakeholders, ensuring claims are resolved efficiently.

The ideal candidate will have a Bachelor’s degree and preferably three or more years of experience, with strong analytical and communication skills. Benefits include health insurance and a 401(k) plan.

Qualificações

• 3+ years of related experience or equivalent education.
• Ability to manage very complex claims independently.

Responsabilidades

• Manage a caseload of 150 to 180 workers’ compensation files.
• Communicate with claimants and providers regarding claims.
• Determine compensability of claims and administer benefits.

Conhecimentos

Analytical skills

Technical knowledge of statutory regulations

Excellent written and verbal communication skills

Proficiency in Word and Excel

Formação académica

Bachelor’s degree in a related field

Descrição da oferta de emprego

Position Summary

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

Responsibilities

• Effectively manages a caseload of 150 to 180 workers’ compensation files, including very complex claims.
• Initiates and conducts investigations in a timely manner.
• Determines compensability of claims and administers benefits based upon state law and company guidelines.
• Manages medical treatment and billing, authorizing as appropriate.
• Refers cases to external defense counsel; directs and manages as appropriate.
• Communicates with claimants, providers, and vendors regarding claim issues.
• Computes and sets reserves within company guidelines; limits are larger than those for Claims Examiner I and II.
• Settles and/or finalizes all claims and obtains authority as designated.
• Maintains diary system for case review and documents file to reflect status and work performed.
• Communicates appropriate information promptly to the client to resolve claims efficiently, including injury trends or safety concerns.
• Adheres to all company policies and procedures.
• Conducts file reviews independently.
• Performs other duties as assigned.

Equipment Operated/Used

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

Special Equipment or Clothing

Appropriate office attire.

Qualifications

• Education/Experience: 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 the ability to convey 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 very complex claims.
  • Proficiency in Word and Excel (preferred).
• Other Qualifications: Certifications and/or licenses as required by state regulation.

Benefits

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