TRISTAR Insurance Group
TRISTAR Insurance Group
TRISTAR Insurance Group — жұмыс берушілерге, сақтандыру компанияларына және мемлекеттік ұйымдарға сақтандыруды әкімшілендіру мен тәуекелдерді басқару қызметтерін ұсынатын ұлттық деңгейдегі үшінші тарап әкімшісі. Компания мүлік пен жазатайым оқиғалардан сақтандыру бағдарламаларын, еңбекке байланысты өтемақыны, жалпы және автокөлік жауапкершілігін, басқарылатын медициналық көмекті, еңбек демалысы мен мүгедектікті басқаруды, қызметкерлердің топтық жеңілдіктерін әкімшілендіруді және жұмыс орнындағы қауіпсіздікті қолдайды. Басқарылатын медициналық көмек бағытындағы мүмкіндіктеріне шоттарды тексеру, жағдайды басқару, медициналық қызметті пайдалану тиімділігін тексеру, мейіргерлік триаж және дәріхана жеңілдіктерін басқару кіреді. TRISTAR технологияға негізделген операцияларын жекелендірілген қызмет көрсету тәсілімен ұштастырып, клиенттеріне күрделі сақтандыру және қызметкерлерге арналған жеңілдіктер қажеттіліктері аясында тәуекелдерді басқаруға көмектеседі.

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.

Сипаттама

  • 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

Талаптар

  • 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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