Key Facts

Remote From:

Full time

English

Hard Skills

Electronic Referrals Case Management Systems Workers' Compensation Medical Abbreviations Organisational Policies Industry Trend Analysis Call Center Experience Business Analysis Stakeholder Communications Productivity Improvement

Other Skills

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Record Keeping
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Organizational Skills
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Quality Assurance
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Computer Literacy
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Client Confidentiality
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Ability To Meet Deadlines
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Communication
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Time Management
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Customer Service

Roles & Responsibilities

Excellent phone demeanor and customer service skills
Ability to work independently and meet deadlines
Knowledge of medical terminology
Understanding of referral criteria by client and/or jurisdictions

Requirements:

Set up member within the case management system
Assist incoming calls to the case management referral department
Monitor dedicated referral emails to review for new referrals and correspondence
Process all referrals and correspondence within 24 hours of receipt

TRISTAR Insurance Group

Insurance

About TRISTAR Insurance Group

TRISTAR began as an insurance program manager and medical malpractice claims administrator in 1987. Workers compensation claims management services were added in our offerings in 1989, and the Company was renamed TRISTAR Risk Management in 1995. As managed care and benefits administration services were added to our offerings, the organization grew into TRISTAR. We are the largest privately held third party claims administrator in United States. We empower more than 1,000+ professionals in offices throughout the United States, focusing business operations in three divisions: property casualty claims management, benefits administration, and managed care services. We are true to our values of RESPECT, INTEGRITY, TRUST, and EXCELLENCE, making the right choices both financially and ethically. At TRISTAR we strive to create an environment of respect, wherein all of us are encouraged to learn and to grow, to provide exceptional service to our clients and in turn to enjoy the satisfaction that comes from a job well done. We believe that to provide real service, we must contribute something which cannot be bought or measured with money: sincerity and integrity. At TRISTAR, you help create a world in which together we "transform risk into opportunity".

Company type: SME

Industry: Insurance

Founded: 2018

Company size: 501 - 1000

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Job description

This is a remote position.

The preferred hours for this position is 9 am - 5:30 pm Pacific time or 12 pm - 8:30 pm Eastern time.

POSITION SUMMARY:

Work directly with the Supervisor and Manager to provide additional resources for the case management staff. This position does not provide any clinical review or decisions.

This individual is responsible for monitoring incoming correspondence received. The coordinator will ensure the referrals are set up in the case management system and promptly assigned to the case manager. The Referral Coordinator will answer incoming calls, screen, respond and route the calls. This position requires the ability to work independently to meet deadlines, as well as an excellent phone demeanor and a desire to provide exceptional customer service. The position requires knowledge of medical terminology, the understanding of referral criteria by client and/or jurisdictions. The referrals may be for WC Utilization Review and or Case Management services.

Responsibilities of the position include, but are not limited to:

Set up of member within the case management system
Assist incoming calls to the case management referral department
Monitor dedicated referral emails to review for new referrals and correspondence

Monitor workflow of referrals and identify areas where daily assistance is needed
Work with the branch locations and staff to complete and provide necessary information for referrals
Process all referrals and correspondence within 24 hours of receipt
Maintain daily/monthly referral logs
Identify trends and/or issues in referral patterns and communicate them with management.

***Other duties as assigned

Additional Functions and Responsibilities

Demonstrates ability to meet administrative requirements, including productivity, time management and Quality Assurance standards
Maintain documentation standards adhering to URAC standards and company policy and procedures
Maintain confidentiality- Knowledge of laws and regulations pertaining to HIPPA and PHI
Other job duties as assigned

Equipment Operated/Used:

Essential Equipment: Desk, Telephone/Fax, Computer Keyboard, Mouse, System Applications

Essential Tools: Pens, pencil, computer, Keyboard

Essential Vehicles: N/A

Special Equipment or Clothing:

Professional attire adhering to the Company Dress Code

Ready to apply?

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