Claims Examiner III

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POSITION SUMMARY: Under minimal supervision, manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. 

This position requires considerable interaction with clients, claimants on the phone, management, other Claims Examiners, and other TRISTAR staff.

DUTIES AND RESPONSIBILITIES:

• Effectively manages a caseload of 150 workers’ compensation files, including very complex claims.*
• Initiates and conducts investigations 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.*
• Refers cases to outside defense counsel.  Directs and manages as appropriate.* 
• Communicates with claimants, providers, and vendors regarding claims issues.*
• Computes and sets reserves within Company guidelines.  Limits are larger than those allowed for Claims Examiner I and Claims Examiner II.*
• Settles and/or finalizes all claims and obtains authority as designated.*
• Maintains diary system for case review and documents file to reflect the status 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.*
• Conducts file reviews independently.*
• Other duties as assigned.

* Essential job function.

EQUIPMENT OPERATED/USED:  Computer, 10-key, fax machine, copier, printer, and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING:  Appropriate office attire