TRISTAR Insurance Group
TRISTAR Insurance Group
TRISTAR Insurance Group एक राष्ट्रीय थर्ड-पार्टी एडमिनिस्ट्रेटर है, जो नियोक्ताओं, बीमा कंपनियों और सार्वजनिक संस्थाओं को बीमा प्रशासन तथा जोखिम प्रबंधन सेवाएँ प्रदान करता है। कंपनी संपत्ति और दुर्घटना बीमा कार्यक्रमों, कर्मचारियों के मुआवज़े, सामान्य और ऑटो देयता, प्रबंधित देखभाल, अनुपस्थिति और दिव्यांगता प्रबंधन, कर्मचारी समूह लाभ प्रशासन तथा कार्यस्थल सुरक्षा में सहायता करती है। इसकी प्रबंधित देखभाल क्षमताओं में बिल समीक्षा, केस प्रबंधन, उपयोग समीक्षा, नर्स ट्रायेज और फार्मेसी लाभ प्रबंधन शामिल हैं। TRISTAR तकनीक-सक्षम संचालन को अनुकूलित सेवा के साथ जोड़कर ग्राहकों को जटिल बीमा और कर्मचारी लाभ संबंधी आवश्यकताओं के बीच जोखिम प्रबंधित करने में सहायता करता है।

Workers Compensation Claims Examiner I - Medical Only (Hybrid)

TRISTAR Insurance Group seeks a hybrid Workers Compensation Claims Examiner I to manage medical-only claims from investigation through resolution. The role covers compensability, treatment and billing coordination, reserves, documentation, and communication with claim stakeholders.

विवरण

  • Manage medical-only workers compensation claims from intake through resolution, keeping total exposure within $10,000 and delegated authority limits
  • Open and complete claim investigations promptly
  • Assess compensability under applicable state laws and company standards
  • Coordinate and oversee medical care and related billing
  • Communicate with claimants, employers, providers, vendors, clients, and TRISTAR personnel
  • Calculate, set, and revise reserves according to delegated authority and company standards
  • Track claims for lost time, potential indemnity exposure, rising medical costs, litigation, and other material changes
  • Escalate claims above $10,000 or outside the medical-only scope to a supervisor
  • Maintain the claim diary and complete, accurate file records
  • Share injury patterns and workplace safety concerns with clients
  • Take part in file reviews and complete other assigned responsibilities

आवश्यकताएँ

  • High school diploma or GED
  • One to three years of relevant work experience
  • Working knowledge of workers compensation laws, statutory obligations, and applicable medical terminology
  • Ability to investigate and administer medical-only claims within delegated authority and established procedures
  • Analytical ability to assess claim facts, medical records, and billing information
  • Judgment to identify increasing exposure or complexity and obtain supervisory direction promptly
  • Strong organization skills, including diary maintenance, task prioritization, and deadline management
  • Clear and effective written and verbal communication
  • Professional ability to work with people across all levels of a business
  • Microsoft Word and Excel proficiency preferred
  • State-required certification or license
  • Ability to perform sedentary work and satisfy the role's mental, visual, and physical demands

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