TRISTAR Insurance Group is a Third Party Administrator for Workers' Compensation claims management (www.tristarrisk.com). Founded in 1987, TRISTAR employs over 700 people with a wide-range of expertise. TRISTAR has over 20 offices nationwide.

Workers' Compensation Claims Examiner I

**Positive Working Environment!**

www.tristarrisk.com

JOB DESCRIPTION:

We currently have an opportunity for a Workers' Compensation professional in our Santa Ana, CA location! If you have 1+ years experience in Workers' Compensation claims, possess exceptional interpersonal, verbal, and written communication skills, provide excellent customer service and are a team player we want to see your resume!

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

DUTIES AND RESPONSIBILITIES: 

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  Effectively manage a caseload of 150 to 180 workers’ compensation files, including complex claims.
  
  
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  Initiate and conduct claims investigation in a timely manner.
  
  
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  Determine compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.
  
  
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  Manage medical treatment and medical billing, authorizing as appropriate.
  
  
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  Refer cases to outside defense counsel as appropriate.  Monitor legal aspects.
  
  
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  Communicate with claimants, providers and vendors regarding claims issues.
  
  
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  Compute and set reserves within Company guidelines. 
  
  
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  Settle and/or finalize all claims and obtain authority as designated.
  
  
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  Maintain diary system for case review and document file to reflect the status and work being performed on the file.
  
  
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  Communicate appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.
  
  
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  Involve TRISTAR loss control staff when appropriate.
  
  
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  Adhere to all Company policies and procedures.
  
  
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  Participate in file reviews, as needed.

QUALIFICATIONS REQUIRED:

Education/Experience:  Bachelor’s degree in related field (preferred); and one (1) to five (5) years related experience; or equivalent combination of education and experience. 

Knowledge, Skills and Abilities:

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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, including ability to convey technical details to claimants, clients and staff.
  
  
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  Ability to interact with persons at all levels in the business environment.
  
  
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  Ability to independently and effectively manage very complex claims.
  
  
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  Proficient in Word and Excel (preferred).

Other Qualifications: 

Self Insured Certificate

Certification and/or or license as required by State regulation.

BENEFITS: Excellent coverage for Medical, Dental, and Vision.  We offer 17 days of paid time off, 8 days of paid holidays, along with 401k with company match, direct deposit, and more!