Claims Examiner III at Boise

Job Description

Claims Examiner III
POSITION SUMMARY:

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

DUTIES AND RESPONSIBILITIES:

• Effectively manage a caseload of workers’ compensation files
• Initiate and conduct investigation in a timely manner.
• Determine compensability of claims and administer benefits, based upon state law in accordance with established Company guidelines.
• Manage medical treatment and medical billing, authorizing as appropriate.
• Refer cases to outside defense counsel. Direct and 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 to reflect the status and work being performed on the file.
• Communicate appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.
• Involve TRISTAR loss control staff when appropriate.
• Adhere to all Company policies and procedures.
• Conduct file reviews independently.
• Other duties as assigned.

Job Requirements

Claims Examiner III
QUALIFICATIONS REQUIRED:
Education/Experience: Bachelor’s degree in related field (preferred); High school diploma or equivalent required. Minimum 5 years experience as workers compensation claims examiner or equivalent combination of education and experience.

Knowledge, Skills and Abilities:

• Self-Insured Plan certificate required
• Experience with hospital accounts preferred
• Advanced customer service skills
• Technical knowledge of statutory regulations and medical terminology
• Good presentation and 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 workers compensation claims
• Proficient in Word, Outlook and Excel (preferred)

Country: USA, State: Idaho, City: Boise, Company: Tristar Risk Management, Inc..