Overview

Claims Examiner III – Workers Remote Jobs in Houston – Texas – USA at Tristar Insurance

Title: Claims Examiner III – Workers Remote

Company: Tristar Insurance

Location: Houston – Texas – USA

Type: Remote/Work from Home

Category: Insurance, Online

Position:  Claims Examiner III – Workers Compensation _ Houston (Remote)
Job Details

Level Experienced Job  Location

Houston 235400 – Houston, TXRemote TypeOptional Work from HomePosition TypeFull TimeEducation Level

High School Diploma or GEDSalary Range$70,000.00 – $75,000.00

Travel PercentageNone Job  Shift Day Job  Category Insurance Claims  Examiner III – Workers Compensation _ Houston (Remote

POSITION SUMMARY:

Requires a Texas Workers Compensation License. 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, and with management, other Claims Examiners, and other TRISTAR staff in the office/remotely; therefore consistently being at work in the office/remotely, in a timely manner, is inherently required of this position.

DUTIES AND RESPONSIBILITIES:

Effectively manages a caseload of 150 to 180 workers’ compensation files, including very complex claims.
* Initiates and conducts investigation in a timely manner.
* Determines compensability of claims and administer 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 set reserves within Company guidelines. 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.
* Adheres to all Company policies and procedures.
* Conducts file reviews independently.
* Other duties as assigned.
* Essential job function.

Qualifications

QUALIFICATIONS REQUIRED:

Education/

Experience:

High School Diploma ired. Bachelor’s degree in related field (preferred); five (5) s 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 tointeract with persons ls in the business environment.

Ability toindependently and effectively manage very complex claims.

Proficient in Word and Excel (preferred).Other

Qualifications:

Texas Workers Compensation License

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