Workers Compensation Claims Examiner III _ Temp

Tristar Insurance; Signal Hill (CA); On-site; USD 94,000 - 104,000; Part time

Benefits offered by this job

Medical, Dental & Vision Insurance

Life & Disability Insurance

401(k) Plan

Paid Time Off

Paid Holidays

Job summary

TRISTAR INSURANCE is seeking an experienced indemnity claims examiner in Signal Hill, CA. The role manages a large caseload of workers’ compensation files from inception to resolution, with substantial client interaction and office presence.

Under minimal supervision, you will investigate, determine compensability, manage medical treatment and billing, and coordinate with counsel as needed. A strong background in claims and regulations is essential.

Qualifications

• Bachelor’s degree in related field; 3+ years experience or equivalent.
• Technical knowledge of statutes and medical terminology.
• Excellent written and verbal communication; able to convey complex details.

Responsibilities

• Manage a caseload of 150–180 workers’ compensation files, including complex claims.
• Initiate and conduct investigations in a timely manner.
• Determine compensability and administer benefits per state law and guidelines.
• Manage medical treatment and billing; authorize as appropriate.
• Refer cases to outside defense counsel and direct/manage as needed.
• Communicate with claimants, providers, and vendors regarding issues.
• Compute and set reserves within guidelines; settle and finalize claims as designated.
• Maintain diary system for review and document status; report trends to client.

Skills

Analytical abilities

Communication skills

Claims management

Interpersonal skills

Education

Bachelor’s degree or equivalent

Tools

Microsoft Word

Microsoft Excel

Job description

Job Details: Level – Experienced | Location – Signal Hill Office, Signal Hill, CA 90755 | Position Type – Temporary | Education Level – High School Diploma or GED | Salary – $93,600.00 - $104,000.00

POSITIONS SUMMARY

Under minimal supervision, manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. Requires substantial interaction with clients, claimants, management, other Claims Examiners, and TRISTAR staff, necessitating consistent office presence.

DUTIES & RESPONSIBILITIES

• Effectively manage a caseload of 150 to 180 workers’ compensation files, including very complex claims.
• Initiate and conduct investigations in a timely manner.
• Determine compensability of claims and administer benefits per state law and company guidelines.
• Manage medical treatment and medical billing, authorizing as appropriate.
• Refer cases to outside defense counsel and direct/manage as appropriate.
• Communicate with claimants, providers, and vendors regarding claims issues.
• Compute and set reserves within company guidelines.
• Settle and/or finalize all claims and obtain authority as designated.
• Maintain diary system for case review and document file status.
• Communicate appropriate 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.

EQUIPMENT USED

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

QUALIFICATIONS

Education & Experience

• Bachelor’s degree in related field (preferred); three (3) or more years related experience; or equivalent combination of education and experience.

Knowledge, Skills & Abilities

• Technical knowledge of statutory regulations and medical terminology.
• Analytical skills.
• Excellent written and verbal communication skills, including 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).

Certifications & Licenses

• 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