Workers Compensation Claims Examiner III

Job Description:

• 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.
• 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.

Requirements:

• Bachelor’s degree in a related field (preferred)
• Three (3) or more years of related experience; or equivalent combination of education and experience.
• WC Adjuster’s license for MI & MN preferred but will also consider an adjuster's license for TX, FL & Indiana
• 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 independently and effectively manage very complex claims.
• Proficient in Word and Excel (preferred).

Benefits:

• Medical, Dental & Vision Insurance
• Life and Disability Insurance
• 401(k) plan
• Paid time off
• Paid holidays
• Referral bonus

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