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 II

Handle 150–180 moderate-to-complex workers’ compensation indemnity claims from intake through resolution. Set reserves, approve payments and settlements, coordinate defense counsel, and monitor litigation within assigned authority.

विवरण

  • Oversee approximately 150–180 moderate-to-complex workers’ compensation claims
  • Manage indemnity claims from initial assignment through resolution in line with authority limits and company or client guidelines
  • Calculate and set claim reserves
  • Approve payments and settlements within delegated authority
  • Recognize and escalate high-exposure claims, unusual compensability issues, sensitive client matters, and decisions beyond assigned authority
  • Refer claims to defense counsel when appropriate
  • Track litigation activity
  • Discuss significant legal developments and settlement strategy with the supervisor
  • Apply independent judgment to routine and complex claims decisions
  • Obtain supervisory direction for unusual, high-exposure, or sensitive claims

आवश्यकताएँ

  • High school diploma or GED
  • Bachelor’s degree in a related discipline preferred
  • Three to five years of relevant experience, or an equivalent combination of education and experience
  • Working knowledge of statutory regulations and medical terminology
  • Strong analytical ability
  • Excellent written and verbal communication skills, including the ability to explain technical information to claimants, clients, and staff
  • Ability to work effectively with people at all levels of a business organization
  • Ability to independently manage highly complex claims effectively
  • Proficiency with Microsoft Word and Excel preferred
  • State-required certification or licensure

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