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Fresno

    Claims Examiner III- TEMPORARY in office/hybrid locally - Fresno, United States - Tristar Insurance Services LLC

    Tristar Insurance Services LLC
    Tristar Insurance Services LLC Fresno, United States

    4 weeks ago

    Default job background
    Description
    Job Details

    Level
    Experienced

    Job Location
    Fresno Office - Fresno, CA

    Remote Type
    Fully Remote

    Position Type
    Full Time

    Education Level
    High School Diploma or GED

    Salary Range
    $ $45.00 Hourly

    Travel Percentage
    None

    Job Shift
    Day

    Job Category
    Insurance

    Claims Examiner III- potentially remote

    This position IS TEMPORARY, remote

    Please sign the application at the end. SIP IS REQUIRED

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

    This position 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 indemnity workers' compensation files, including very complex claims.
    • Initiates and conducts investigation in a timely manner based upon state law and TRISTAR Best Practices for claim handling.
    • Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.
    • Manages medical treatment and medical billing, authorizing as appropriate based on Client claims handling guidelines.
    • Able to trigger litigated cases with Client Attorney without supervisor to establish plan of action and obtain settlement authority to commence settlement negotiations with Applicant Attorney.
    • Communicates with claimants, providers and vendors regarding claims issues.
    • Computes and set reserves based upon Client claims handling guidelines with minimal supervision.
    • Negotiates and/or finalize all claims based on settlement authority from the Client.
    • 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 TRISTAR company policies and procedures.
    • Conducts file reviews independently.
    • Other duties as assigned.
    * Essential job function.

    Qualifications

    QUALIFICATIONS REQUIRED:

    This position remote. Please sign the application at the end. SIP required

    Education/Experience:

    Bachelor's degree in related field (preferred) or five (5) or more years related experience; or equivalent combination of education and experience. Experience with handling a public entity account and administering 4850 benefits.

    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:
    • California Self-Insurance Certificate required
    Salary range: $38.50-$40.00 (Negotiable)

    Here are some of the benefits you can enjoy in this role:
    • Medical, Dental, Vision, Disability and Life insurance
    • 401(k) plan
    • Paid Holidays
    • Paid Time off
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