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 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.

Сипаттама

  • 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.

Талаптар

  • 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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