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TRISTAR Insurance Group
TRISTAR Insurance Group
501 – 1.000 Angajați
Asistență medicalăConsultanțăLogistică
TRISTAR Insurance Group este un administrator național de servicii de asigurare pentru terți, care oferă angajatorilor, asigurătorilor și entităților publice servicii de administrare a asigurărilor și de gestionare a riscurilor. Compania sprijină programe pentru bunuri și răspundere civilă, compensații pentru accidente de muncă, răspundere civilă generală și auto, îngrijire medicală coordonată, gestionarea absențelor și dizabilităților, administrarea beneficiilor de grup pentru angajați și siguranța la locul de muncă. Capacitățile sale de îngrijire medicală coordonată includ verificarea facturilor, gestionarea cazurilor, evaluarea utilizării serviciilor, triajul efectuat de asistente medicale și administrarea beneficiilor farmaceutice. TRISTAR combină operațiunile susținute de tehnologie cu servicii adaptate pentru a ajuta clienții să gestioneze riscurile asociate unor nevoi complexe de asigurare și de beneficii pentru angajați.
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Locurile de muncă ale companiei

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.

USStatele Unite ale AmericiiTXTexas
24 $ – 26 $ / oră
HibridNormă întreagăJuniorNu este necesară o diplomăLimbă Obligatorie: englezăSpecialist în daune

Descriere

  • 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

Cerințe

  • 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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