Job Closed
This listing is no longer active.
TEMPORARY- Workers Compensation Claims Examiner III (Remote)
Location
United States
Posted
103 days ago
Salary
$35 - $45 / hour
No structured requirement data.
Job Description
TEMPORARY- Workers Compensation Claims Examiner III (Remote)
Tristar Insurance
Job DetailsLevel: ExperiencedJob Location: Milwaukee - Waukesha, WI 53186Position Type: TemporaryEducation Level: Bachelor's DegreeSalary Range: $35.00 - $45.00 HourlyTravel Percentage: NegligibleJob Shift: DayJob Category: InsurancePOSITION 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 on time is inherently required of this position. DUTIES AND RESPONSIBILITIES: Effectively manages a caseload of 150 or fewer workers’ compensation files, including complex claims.* Initiates and investigates promptly.* Determines compensability of claims and administers benefits based upon state law and following 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 more significant than those allowed for Claims Examiner I and Claims Examiner II.* Settles and finalizes all claims and obtains authority as designated.* Maintains diary system for case review and documents file to reflect the status and work performed on the file.* Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety-related concerns.* Involves TRISTAR loss control staff when appropriate.* 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 QualificationsQUALIFICATIONS REQUIRED: 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 conveying 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). *This person must have a MN license and sit in-office where applicable Mental and Physical Requirements: [see separate attachment for a copy of the checklist of mental and physical requirements] MENTAL AND PHYSICAL REQUIREMENTS 1. MENTAL EFFORT a. Reasoning development: Follow one- or two-step instructions; routine, repetitive task. Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables. Follow written, verbal, or diagrammatic instructions; several concrete variables. X Solve practical problems; variety of variables with limited standardization; interpret instructions. Logical or scientific thinking to solve problems; several abstract and concrete variables. Wide range of intellectual and practical problems; comprehend most obscure concepts. b. Mathematical development: Simple additional and subtraction; copying figures, counting, and recording. Add, subtract, multiply, and divide whole numbers. X Arithmetic calculations involving fractions, decimals, and percentages. Arithmetic, algebraic, and geometric calculations. Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination. Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application. c. Language development: Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing. Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction. Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants. X Ability to compose original correspondence, follow technical manuals, and have increased contact with people. Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data. 2. PHYSICAL EFFORT a. Physical activity required to perform the job: Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met. X Light work: a. Exerting up to 20 pounds of force occasionally b. Exerting up to 10 pounds frequently c. Exerting a negligible amount of force constantly to move objects (If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work). Medium work: a. Exerting up to 50 pounds of force occasionally b. Exerting up to 20 pounds of force frequently c. Exerting up to 10 pounds of force constantly to move objects Heavy work: a. Exerting up to 100 pounds of force occasionally b. Exerting up to 50 pounds of force frequently c. Exerting up to 20 pounds of force constantly to move objects Very heavy work: a. Exerting in excess of 100 pounds of force occasionally b. Exerting in excess of 50 pounds of force constantly to move objects c. Exerting in excess of 20 pounds of force constantly to move objects Visual requirements necessary to perform the job: Far vision: clarity of vision at 20 feet or more X Near vision: clarity of vision at 20 inches or less X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are Color vision: ability to identify and distinguish colors Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point 2. PHYSICAL EFFORT (cont.) FREQUENCY c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally): Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion. Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium. X Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles. X Kneeling: Bending legs at knee to come to a rest on knee or knees. X Crouching: Bending the body downward and forward by bending legs and spine. Crawling: Moving about on hands and knees or hands and feet. X Reaching: Extending hand(s) and arm(s) in any direction. X Standing: Particularly for sustained periods of time. X Walking: Moving about on foot to accomplish tasks, particularly for long distances. X Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward. X Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion. Foot Motion: Using feet to push pedals. X Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles. X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling. X Grasping: Applying pressure to an object with the fingers and palm. Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Frequently Frequently Occasionally 2. PHYSICAL EFFORT (cont.) FREQUENCY X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly. X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts. Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips. X Repetitive Substantial movements (motions) of the wrists, hands, Motion: and/or fingers. Frequently Frequently Frequently 3. WORKING CONDITIONS Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure. WORKING CONDITION ENVIRONMENTAL FACTOR NATURE/REASON OF EXPOSURE FREQUENCY Dirt/Dust Noise Temperature extremes Dampness Vibrations Equipment movement hazard Chemicals/solvents Electrical shock Significant work pace/pressure Odors/Fumes Other (specify):
Related Guides
Related Categories
Related Job Pages
More Claims Specialist Jobs
Líder de Diseño Técnico e Integraciones
SofkaRetos técnicos y personales que te mantendrán en constante crecimiento. Un equipo conectado, enfocado en tu bienestar físico y mental. Cultura de mejora continua, fresca y colaborativa, con oportunidades de aprendizaje y gente dispuesta a apoyarte. Programas como Happy Kaizen y WeSofka que cuidan tu bienestar físico y emocional.
✨ ¿Estás buscando nuevos desafíos y un lugar donde puedas disfrutar de un ambiente cercano mientras aprendes constantemente? ¡Bienvenido a un equipo con un propósito claro: "TRANSFORMAR la vida de las personas siendo el aliado TECNOLÓGICO más confiable"! 🚀 ¡Prepárate y únete a esta aventura! ¿Qué encontrarás? - Retos técnicos y personales que te mantendrán en constante crecimiento. - Un equipo conectado, enfocado en tu bienestar físico y mental.🌱 - Cultura de mejora continua, fresca y colaborativa, con oportunidades de aprendizaje y gente dispuesta a apoyarte. - KaizenHub, un programa diseñado para potenciar tus talentos, con feedback, mentorías y coaching a través de Sofka U. ¡Será un reto y un juego a la vez! 🧠 - Programas como Happy Kaizen y WeSofka que cuidan tu bienestar físico y emocional. ¿Te apasiona transformar visiones estratégicas en arquitecturas de alta precisión? Buscamos un Líder de Diseño Técnico con más de 3 a 4 años de experiencia liderando el desarrollo e integración de soluciones complejas. Tu enfoque principal será el análisis de flujos de datos y la definición de contratos de interfaz, asegurando que cada componente técnico encaje perfectamente en el ecosistema digital. Si dominas el diseño de APIs bajo el estándar OpenAPI/Swagger y tienes un sólido recorrido en el sector bancario, este perfil es para ti. Este rol es fundamental para garantizar la excelencia técnica en nuestras células de desarrollo. Tendrás la oportunidad de liderar la hoja de ruta de integración del Banco, impactando directamente en la robustez de nuestros servicios financieros y asumiendo un liderazgo técnico que trasciende el código. Responsabilidades - Analizar de forma detallada los insumos y productos para definir con precisión los datos de entrada, salida, transformaciones y validaciones técnicas. - Elaborar artefactos de diseño técnico, incluyendo contratos de interfaz (Swagger / OpenAPI) y diagramas de secuencia detallados. - Supervisar técnicamente a los equipos de desarrollo para asegurar el cumplimiento de las definiciones y resolver bloqueos de infraestructura o conectividad. - Coordinar y sustentar los requerimientos técnicos ante las áreas de Integraciones, Core Bancario (AS400/RPG), Datos y Seguridad. - Gestionar el ciclo de vida del diseño, desde la concepción del detalle hasta la fase de construcción, garantizando la fidelidad del producto final. - Determinar la estructura de datos y el flujo lógico más eficiente para resolver integraciones financieras de alta complejidad. Requisitos - Formación: Profesional en Ingeniería de Sistemas, Computación o carreras afines. - Experiencia: Mínimo 3 a 4 años en roles de diseño técnico o liderazgo de desarrollo, con un fuerte enfoque en integraciones y procesos del sector bancario. Conocimientos Técnicos - Diseño y comprensión avanzada de APIs (OpenAPI / Swagger). - Herramientas de diagramación técnica (C4, UML, Diagramas de Secuencia y Flujo). - Flujos financieros y procesos del sector bancario. - Metodologías de arquitectura y diseño (Deseable TOGAF o BIAN). - Gestión de conectividad, puertos y permisos de infraestructura técnica. ¡PRESENTATE y sé parte de esta historia! Condiciones - Contrato a término indefinido ¡Queremos relaciones a largo plazo y que seas parte de nuestra familia por mucho tiempo! - ¿Buscas crecimiento profesional? En Sofka, te ofrecemos un ecosistema de aprendizaje con múltiples herramientas para cerrar brechas y potenciar tus habilidades. ¡Tú decides cómo quieres crecer!
A dynamic organization supplying quality claims outsource solutions to insurance carriers, countrywide is seeking multi-line adjusters in your area. There are many competing vendors in our marketplace, but we are not your typical “vendor”. Our company was built by insurance company claims executives to support insurance companies’ claim operations to help them meet their organizations goal of providing quality claims solutions at a reasonable cost. We excel in providing professional, knowledgeable claims professionals to handle large losses, catastrophe claims, business interruption and daily property claims, as well as handle complete liability investigations, task assignments including scene investigations and property damage appraisals, construction defect claims as well as first party automobile claims for personal and commercial insurance policyholders. Position Summary: A national independent insurance adjusting firm has immediate openings for Multi-Line Claims adjusters that possess the ability to work remotely and have the experience to handle both property and liability claims. The candidate must possess the ability to adjust commercial and residential property losses and must also have a working knowledge of how to determine negligence and assess damages. The candidate should be able to perform all tasks with modest supervision. The candidate must possess the ability to understand coverage, how to investigate a variety of property and negligence claims, how to value and estimate property damage as well as the ability to evaluate Bodily Injury damages for settlement. Requirements: - Minimum 5 years first-party commercial and/or residential property and liability adjusting experience - Maintain own current estimating software; Xactimate preferred - Working computer; internet access and Microsoft Word required - Must demonstrate strong time management and customer service skills - Ability to take recorded statements in the field or with legal representatives - Experience in preparing Statements of Loss, Proofs of Loss, and denial letters - State adjuster’s license where required - Must have valid driver’s license Knowledge and Skills: - In-depth knowledge of property and liability insurance coverage and industry standards - Prepare full captioned reports by collecting and summarizing information required by client - Strong verbal and written communications skills - Prompt, reliable, and friendly service - Must submit to background check; void in states where prohibited - Experience in industry specific areas a plus, but not necessary: fire departments, agricultural, lumber mills, high value or historic buildings or Construction Defects, Automobile Liability, Subrogation Recovery investigations Responsibilities: - Completes residential and commercial field property inspections utilizing Xactimate software and general liability field investigations to determine negligence and damages - Investigate claims by obtaining recorded statements from insureds, claimants or witnesses; by interviewing fire, police or other governmental officials as well as inspecting claimed damages - Recommend claim reserves based on investigation, through well supported reserve report - Obtain and interpret official reports - Review applicable coverage forms and endorsement, providing thorough analysis of coverage and any coverage issues in well documented initial captioned report to client - Maintain acceptable product quality through compliance with established Best Practices of client Preferred but Not Required: - College Degree - AIC, or other professional designations All candidates must pass a full background check
A dynamic organization supplying quality claims outsource solutions to insurance carriers, countrywide is seeking multi-line adjusters in your area. There are many competing vendors in our marketplace, but we are not your typical “vendor”. Our company was built by insurance company claims executives to support insurance companies’ claim operations to help them meet their organizations goal of providing quality claims solutions at a reasonable cost. We excel in providing professional, knowledgeable claims professionals to handle large losses, catastrophe claims, business interruption and daily property claims, as well as handle complete liability investigations, task assignments including scene investigations and property damage appraisals, construction defect claims as well as first party automobile claims for personal and commercial insurance policyholders. Position Summary: A national independent insurance adjusting firm has immediate openings for Multi-Line Claims adjusters that possess the ability to work remotely and have the experience to handle both property and liability claims. The candidate must possess the ability to adjust commercial and residential property losses and must also have a working knowledge of how to determine negligence and assess damages. The candidate should be able to perform all tasks with modest supervision. The candidate must possess the ability to understand coverage, how to investigate a variety of property and negligence claims, how to value and estimate property damage as well as the ability to evaluate Bodily Injury damages for settlement. Requirements: - Minimum 5 years first-party commercial and/or residential property and liability adjusting experience - Maintain own current estimating software; Xactimate preferred - Working computer; internet access and Microsoft Word required - Must demonstrate strong time management and customer service skills - Ability to take recorded statements in the field or with legal representatives - Experience in preparing Statements of Loss, Proofs of Loss, and denial letters - State adjuster’s license where required - Must have valid driver’s license Knowledge and Skills: - In-depth knowledge of property and liability insurance coverage and industry standards - Prepare full captioned reports by collecting and summarizing information required by client - Strong verbal and written communications skills - Prompt, reliable, and friendly service - Must submit to background check; void in states where prohibited - Experience in industry specific areas a plus, but not necessary: fire departments, agricultural, lumber mills, high value or historic buildings or Construction Defects, Automobile Liability, Subrogation Recovery investigations Responsibilities: - Completes residential and commercial field property inspections utilizing Xactimate software and general liability field investigations to determine negligence and damages - Investigate claims by obtaining recorded statements from insureds, claimants or witnesses; by interviewing fire, police or other governmental officials as well as inspecting claimed damages - Recommend claim reserves based on investigation, through well supported reserve report - Obtain and interpret official reports - Review applicable coverage forms and endorsement, providing thorough analysis of coverage and any coverage issues in well documented initial captioned report to client - Maintain acceptable product quality through compliance with established Best Practices of client Preferred but Not Required: - College Degree - AIC, or other professional designations All candidates must pass a full background check
A dynamic organization supplying quality claims outsource solutions to insurance carriers, countrywide is seeking multi-line adjusters in your area. There are many competing vendors in our marketplace, but we are not your typical “vendor”. Our company was built by insurance company claims executives to support insurance companies’ claim operations to help them meet their organizations goal of providing quality claims solutions at a reasonable cost. We excel in providing professional, knowledgeable claims professionals to handle large losses, catastrophe claims, business interruption and daily property claims, as well as handle complete liability investigations, task assignments including scene investigations and property damage appraisals, construction defect claims as well as first party automobile claims for personal and commercial insurance policyholders. Position Summary: A national independent insurance adjusting firm has immediate openings for Multi-Line Claims adjusters that possess the ability to work remotely and have the experience to handle both property and liability claims. The candidate must possess the ability to adjust commercial and residential property losses and must also have a working knowledge of how to determine negligence and assess damages. The candidate should be able to perform all tasks with modest supervision. The candidate must possess the ability to understand coverage, how to investigate a variety of property and negligence claims, how to value and estimate property damage as well as the ability to evaluate Bodily Injury damages for settlement. Requirements: - Minimum 5 years first-party commercial and/or residential property and liability adjusting experience - Maintain own current estimating software; Xactimate preferred - Working computer; internet access and Microsoft Word required - Must demonstrate strong time management and customer service skills - Ability to take recorded statements in the field or with legal representatives - Experience in preparing Statements of Loss, Proofs of Loss, and denial letters - State adjuster’s license where required - Must have valid driver’s license Knowledge and Skills: - In-depth knowledge of property and liability insurance coverage and industry standards - Prepare full captioned reports by collecting and summarizing information required by client - Strong verbal and written communications skills - Prompt, reliable, and friendly service - Must submit to background check; void in states where prohibited - Experience in industry specific areas a plus, but not necessary: fire departments, agricultural, lumber mills, high value or historic buildings or Construction Defects, Automobile Liability, Subrogation Recovery investigations Responsibilities: - Completes residential and commercial field property inspections utilizing Xactimate software and general liability field investigations to determine negligence and damages - Investigate claims by obtaining recorded statements from insureds, claimants or witnesses; by interviewing fire, police or other governmental officials as well as inspecting claimed damages - Recommend claim reserves based on investigation, through well supported reserve report - Obtain and interpret official reports - Review applicable coverage forms and endorsement, providing thorough analysis of coverage and any coverage issues in well documented initial captioned report to client - Maintain acceptable product quality through compliance with established Best Practices of client Preferred but Not Required: - College Degree - AIC, or other professional designations All candidates must pass a full background check