Claims Examiner I _Medical Only (Hybrid)

About the position

The Claims Examiner I position at TRISTAR Risk Management is a hybrid role focused on managing Medical Only claims from inception to conclusion. The role involves significant interaction with clients, claimants, providers, and other staff, requiring timely communication and adherence to company guidelines. As proficiency is established, responsibilities may expand to include handling minor lost time and future medical claims.

Responsibilities
? Effectively manages a caseload of 150 to 200 workers compensation files.
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? Initiates and conducts claims investigation in a timely manner.
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? Determines compensability of claims and administers benefits based on state laws and company guidelines.
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? Manages medical treatment and medical billing, authorizing requests as appropriate.
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? Communicates with claimants, providers, and vendors regarding claims issues.
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? Computes and sets reserves within company guidelines.
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? Finalizes all claims and obtains necessary authority.
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? Maintains a diary system for case review and documentation.
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? Communicates relevant information promptly to clients to resolve claims efficiently.
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? Involves designated loss control staff when appropriate.
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? Adheres to all company policies and procedures.
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? Participates in file reviews as needed.

Requirements
? Bachelor's degree in a related field (preferred) and one year of related experience, or equivalent combination of education and experience.
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? Technical knowledge of statutory regulations and medical terminology.
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? Analytical skills.
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? Excellent written and verbal communication skills.
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? Ability to interact with persons at all levels in the business environment.
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? Proficient in Microsoft Word and Excel.

Nice-to-haves
? Certification and/or license as required by State regulation.

Benefits
? Medical, Dental & Vision Insurance
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? Life & Disability insurance
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? 401(k) plan
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? Paid time off
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? Paid holidays
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? Referral bonus

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