Workers' Claims Examiner III; Hybrid- REMOTE

Position: Workers' Compensation Claims Examiner III (Hybrid- REMOTE)
# Workers' Compensation Claims Examiner III (Hybrid- REMOTE)
Fully Remote   
• Fresno Office - Fresno, CA 93727

Education Level High School Diploma or GED## Workers' Compensation Claims Examiner III (Hybrid- REMOTE)
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* POSITION SUMMARY:

** Under general supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. This position requires considerable interaction with clients, claimants on the phone, and with management, other Claims Examiners, and other TRISTAR staff in the office; therefore consistently being at work in the office, in a timely manner, is inherently required of this position.
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* DUTIES AND RESPONSIBILITIES:

*** Effectively manages a caseload of 150 to 180 workers’ compensation files, including complex claims.
* Initiates and conducts claims investigation in a timely manner.
* Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.
* Manages medical treatment and medical billing, authorizing as appropriate.
* Refers cases to outside defense counsel as appropriate.  Monitors legal aspects.
* Communicates with claimants, providers and vendors regarding claims issues.
* Computes and set reserves within Company guidelines.  Limits are less than those allowed for Claims Examiner III, but larger than those for Claims Examiner I.
* Settles and/or finalize all claims and obtains authority as designated.
* Maintains diary system for case review and document file to reflect the status 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.
* Other duties as assigned. Essential job function.
** EQUIPMENT OPERATED/USED:
** Computer, 10-key, fax machine, copier, printer and other office equipment.
** SPECIAL EQUIPMENT OR CLOTHING:
** Appropriate office attire.

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:

Other

Qualifications:

Mental and

Physical Requirements:

[see separate attachment for a copy of checklist of mental and physical requirements]
Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.
Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.
Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants. X       Ability to compose original correspondence, follow technical manuals, and have increased contact with people.
Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.
Depth perception:  the ability to judge distance and space relationships, so as to see objects where and as they actually are
Color vision:  ability to identify and distinguish colors
Field of vision:  ability to observe an area up or down or to the right or left while eyes are fixed on a given point X    Walking:
Moving about on foot to accomplish tasks, particularly for long distances. X   Hearing:
Perceiving the nature of sounds with or without correction.  Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts.
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