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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 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.

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

Descriere

  • 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.

Cerințe

  • 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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