Workers Compensation Claims Examiner III _ Temp

Tristar Insurance; Chino Hills (CA); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical, Dental & Vision Insurance

Life & Disability Insurance

401(k) plan

Paid time off

Paid holidays

Referral bonus

Job summary

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.

Qualifications

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

Responsibilities

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

Skills

Analytical skills

Technical knowledge of statutory regulations

Excellent written and verbal communication skills

Proficiency in Word and Excel

Education

Bachelor’s degree in a related field

Job description

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