Details: Who are we? TRISTAR Insurance Group is a Third Party Administrator for Workers' Compensation claims management (www.tristarrisk.com). Founded in 1987, TRISTAR employs over 600 people with a wide-range of expertise. Headquartered in Long Beach, California, TRISTAR has over 20 offices nationwide. TRISTAR Risk Management has many temporary and full-time employment opportunities for Claims Examiners in Workers Compensation located in our various branches nationwide. Candidates from intermediate to senior level preferred, but entry level candidates with exposure to Workers Compensation or with related Claims experience will also be considered. If you have experience administering 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! Experience w/public entity accounts (city or county) is a plus! To be considered for any of our current or future opportunities, please visit our Website: www.tristarrisk.com or click on https://home.eease.adp.com/recruit2/?id=1510661&t=1 POSITION SUMMARY: Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. DUTIES AND RESPONSIBILITIES: Effectively manage a caseload of workers’ compensation files Initiate and conduct investigation in a timely manner. Determine compensability of claims and administer benefits, based upon state law in accordance with established Company guidelines. Manage medical treatment and medical billing, authorizing as appropriate. Refer cases to outside defense counsel. Direct and manage as appropriate. Communicate with claimants, providers and vendors regarding claims issues. Compute and set reserves within Company guidelines. Settle and/or finalize all claims and obtain authority as designated. Maintain diary system for case review and document file to reflect the status and work being performed on the file. Communicate appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns. Involve TRISTAR loss control staff when appropriate. Adhere to all Company policies and procedures. Conduct file reviews independently. Other duties as assigned.
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