transforming risk into opportunity
Claims Examiner I – Medical Only Adjuster Experience
Location
Texas
Posted
1 day ago
Salary
$40K - $50K / year
Seniority
Junior
Job Description
Claims Examiner I – Medical Only Adjuster Experience
TRISTAR Insurance Group
• Effectively manages a caseload of 150 to 180 workers’ compensation files. • Initiates and conducts claims 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. • Communicates with claimants, providers, and vendors regarding claims issues. • Computes and sets reserves within Company guidelines. • Maintains a diary system for case review and document file to reflect the status of 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. • Involves TRISTAR loss control staff when appropriate. • Adheres to all Company policies and procedures. • Participates in file reviews, as needed.
Job Requirements
- Minimum of one (1) year related experience; or equivalent combination of education and experience.
- 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.
- Proficient in Word and Excel (preferred).
Benefits
- Medical, Dental, Vision Insurance.
- Life and Disability Insurance.
- 401(k) Plan
- Paid Holidays
- Paid Time Off.
- Referral bonus.
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