Workers Compensation Claims Examiner III _ Temp

TRISTAR RISK MANAGEMENT; Signal Hill (CA); On-site; USD 93,600 - 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 RISK MANAGEMENT is seeking an experienced Claims Examiner to manage all aspects of indemnity claims handling in Signal Hill, CA. Candidates should possess a Bachelor's degree and at least three years of related experience.

The role involves comprehensive file management, investigation, and communication with clients to ensure efficient claims resolution. Benefits include medical, dental, vision insurance and a 401(K) plan.

Qualifications

• Bachelor's degree in a related field (preferred) or equivalent experience.
• Three or more years related experience in claims handling.

Responsibilities

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

Skills

Technical knowledge of statutory regulations

Excellent written and verbal communication skills

Analytical skills

Ability to interact with persons at all levels

Proficient in Word and Excel

Education

Bachelor's degree in related field

Three or more years related experience

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 Range: $93,600.00 – $104,000.00
• Travel Percentage: None
• 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 considerable interaction with clients, claimants on the phone, and with management, other Claims Examiners, and other TRISTAR staff in the office; therefore consistently being at work in the office, in a timely manner, is inherently required of this position.

Duties and Responsibilities

• Effectively manages a caseload of 150 to 180 workers’ compensation files, including very complex claims.
• Initiates and conducts investigation in a timely manner.
• Determines compensability of claims and administers benefits, based upon state law and in accordance with established Company guidelines.
• Manages medical treatment and medical billing, authorizing as appropriate.
• Refers cases to outside defense counsel; directs and manages as appropriate.
• Communicates with claimants, providers and vendors regarding claims issues.
• Computes and sets reserves within Company guidelines. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II.
• Settles and/or finalizes all claims and obtains authority as designated.
• Maintains diary system for case review and documents file to reflect the status and work being performed on the file.
• Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.
• Adheres to all Company policies and procedures.
• Conducts file reviews independently.
• 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: Bachelor’s degree in related field (preferred); three (3) or more years 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 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.
  • Proficient 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

Mental and Physical Requirements

See separate attachment for a copy of checklist of mental and physical requirements.

Mental Effort

• Reasoning development: follows one‑ or two‑step instructions; routine, repetitive task.
• Multi‑step reasoning; logical or scientific thinking to solve problems; many abstract and concrete variables.

Mathematical Development

• Basic arithmetic: addition, subtraction, multiplication, division of whole numbers.
• Advanced calculations: fractions, decimals, percentages; algebraic, geometric.
• Advanced statistical techniques such as calculus, factor analysis, probability determination.

Language Development

• Understanding and following verbal or written instructions.
• Transcribing dictation; writing letters or routine correspondence.
• Ability to compose original correspondence; interpret technical manuals; produce analytical reports.

Physical Effort

• Light work: up to 20 pounds occasionally/frequently.
• Medium work: up to 50 pounds occasionally, up to 20 pounds frequently.
• Heavy work: up to 100 pounds occasionally, up to 50 pounds frequently.
• Very heavy work: >100 pounds occasionally, >50 pounds constantly.

Miscellaneous Physical Activities

• Stooping, kneeling, crouching, reaching, standing, walking, pushing, pulling, lifting, fingering, grasping, etc., with frequencies indicated as occasional or frequent.

Working Conditions

• Dirt/Dust
• Noise
• Temperature extremes
• Dampness
• Vibrations
• Equipment movement hazard
• Chemicals/solvents
• Electrical shock
• Significant work pace/pressure
• Odors/Fumes
• Other (specify):