Claims Examiner I (Medical Only adjuster experience)

Please make sure to complete all the questions in the application and continue through to the end in order to sign and submit it. Please note that this position is a hybrid, temp-to-hire opportunity. **POSITION SUMMARY:** Under close supervision, manages all aspects of medical-only claims handling from inception to conclusion within established authority and guidelines. This position requires considerable interaction with clients and claimants on the phone, and with management, other Claims Examiners, and other TRISTAR staff in the office; therefore, consistently being at work in the office, in a timely manner, is inherently required of this position. **DUTIES AND RESPONSIBILITIES:** - Effectively manages a caseload of 150 to 180 workers’ compensation files.\* - Initiates and conducts claims investigation in a timely manner.\* - Determines compensability of claims and administers benefits, based upon state law and in accordance with established Company guidelines.\* - Manages medical treatment and medical billing, authorizing as appropriate.\* - Communicates with claimants, providers, and vendors regarding claims issues.\* - Computes and sets reserves within Company guidelines. - Maintains a diary system for case review and document file to reflect the status of and work being performed on the file.\* - Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety-related concerns.\* - Involves TRISTAR loss control staff when appropriate.\* - Adheres to all Company policies and procedures.\* - Participates in file reviews, as needed. - Other duties as assigned. \*Essential job function. **EQUIPMENT OPERATED/USED:** Computer, telephone, 10-key, fax machine, printers and other basic office equipment. **QUALIFICATIONS REQUIRED:** Education/Experience: Minimum of one (1) year related experience; or equivalent combination of education and experience. Knowledge, Skills and Abilities: - Technical knowledge of statutory regulations and medical terminology. - Analytical skills. - Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff. - Ability to interact with persons at all levels in the business environment. - Proficient in Word and Excel (preferred). Other Qualifications: **Here are some of the benefits you can enjoy in this role:** - Medical, Dental, Vision Insurance. - Life and Disability Insurance. - 401(k) Plan - Paid Holidays - Paid Time Off. - Referral bonus. Mental and Physical Requirements: [see separate attachment for a copy of checklist of mental and physical requirements] | **MENTAL AND PHYSICAL REQUIREMENTS** | | --- | | **1. MENTAL EFFORT** a. Reasoning development: Follow one- or two-step instructions; routine, repetitive task. Carry out detailed but uninvolved written or verbal instructions; deal with a few concrete variables. Follow written, verbal, or diagrammatic instructions; several concrete variables. X Solve practical problems; variety of variables with limited standardization; interpret instructions. Logical or scientific thinking to solve problems; several abstract and concrete variables. Wide range of intellectual and practical problems; comprehend most obscure concepts. | | b. Mathematical development: Simple addition and subtraction; copying figures, counting, and recording. Add, subtract, multiply, and divide whole numbers. X Arithmetic calculations involving fractions, decimals, and percentages. Arithmetic, algebraic, and geometric calculations. Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination. Highly complex mathematical and statistical techniques, such as calculus, factor analysis, and probability determination; requires theoretical application. | | c. Language development: Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies ve…