Workers Compensation Claims Examiner III

Overview

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, 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.

Responsibilities

• Handle loss time Workers' Compensation claims in TX Office—Texas Jurisdiction
• Handle claims as per BP, SOC 1 and client CHI's
• Prepare a formal captioned report on claims meeting client requirements
• Be well organized and maintain a CAN DO attitude
• Communicate effectively in a professional manner
• Provide great customer service
• Assist employers and their employees in understanding the WC process
• Investigate, evaluate, determine compensability, pay benefits timely as required and comply with all statutory requirements
• Maintain a good sense of urgency
• Get along well with others with a positive attitude

Equipment / Work Environment

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

SPECIAL EQUIPMENT OR CLOTHING : Follow company dress code.

Qualifications

Education / Experience

High School Diploma or GED required; Bachelor's degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience.

Other Qualifications

Workers' Compensation Adjusters License current for the State of Texas

Mental and Physical Requirements

a. Reasoning development : Follow one- or two-step instructions; routine, repetitive task; carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables; follow written / verbal instructions; several concrete variables; solve practical problems; wide range of intellectual and practical problems.

a. Physical activity required to perform the job : Sedentary to light to moderate work as described; refer to job description for specifics.

Disagreeable job conditions to which the employee may be exposed and the frequency of exposure : Dirt / Dust, Noise, Temperature extremes, Dampness, Vibrations, Equipment movement hazard, Chemicals / solvents, Electrical shock, Odors / Fumes, significant work pace / pressure, etc.

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