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TRISTAR Insurance Group
TRISTAR Insurance Group
501 – 1,000 कर्मचारी
परामर्शलॉजिस्टिक्सस्वास्थ्य सेवा
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।
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कंपनी की नौकरियाँ

Workers' Compensation Claims Examiner I – Medical Only (Hybrid)

TRISTAR Insurance Group is seeking a hybrid Workers’ Compensation Claims Examiner I to handle medical-only claims. The role covers investigations, treatment and billing coordination, reserves, communications, and accurate claims documentation.

USसंयुक्त राज्यTXटेक्सास
$24 – $26 / घंटा
हाइब्रिडपूर्णकालिकजूनियरडिग्री आवश्यक नहींआवश्यक भाषा: अंग्रेज़ीदावा विशेषज्ञ

विवरण

  • Handle medical-only workers’ compensation claims from intake through resolution, keeping total exposure at or below $10,000 and operating within delegated authority.
  • Conduct prompt investigations and collect the information required for claim evaluation.
  • Assess compensability in line with applicable state laws and TRISTAR guidelines.
  • Coordinate medical care and billing, issuing treatment or payment authorization within assigned authority.
  • Discuss claim status, treatment, billing, and related issues with claimants, employers, providers, vendors, clients, and TRISTAR personnel.
  • Set, calculate, and revise claim reserves according to authority limits and company standards.
  • Watch for lost time, possible indemnity benefits, rising medical costs, litigation, or other developments that warrant supervisory involvement.
  • Escalate claims that exceed $10,000 in exposure or fall outside the medical-only scope.
  • Use the diary system for scheduled reviews and maintain complete, accurate claim files.
  • Share relevant client information, including injury patterns and safety issues.
  • Follow company procedures, policies, and client-specific claims-handling directions.
  • Support file reviews and complete additional assigned responsibilities.

आवश्यकताएँ

  • High school diploma or GED is the stated education requirement.
  • A bachelor’s degree in a related discipline is preferred.
  • One to three years of relevant experience is required.
  • An equivalent combination of education and experience may be considered.
  • Working knowledge of workers’ compensation laws, statutory obligations, and medical terminology used in medical-only claims.
  • Capability to investigate and administer medical-only claims within delegated authority and established procedures.
  • Analytical ability to assess claim details, medical records, and billing information.
  • Judgment to identify changes in exposure or complexity and promptly involve a supervisor.
  • Strong organization skills, including diary management, task prioritization, and deadline control.
  • Clear and effective written and spoken communication.
  • Professional, comfortable interaction with people at all levels of the business.
  • Microsoft Word and Excel proficiency is preferred.
  • Maintain any certification or license required by state regulations.

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