Medical Only Claims Examiner

TRISTAR Risk Management is a third-party administrator for Workers' Compensation claims management. Founded in 1987, TRISTAR employs over 400 people with a wide-range of expertise. Headquartered in Long Beach, California, TRISTAR has over 14 locations nationwide.

Medical Only Claims Examiner

*Positive Working Environment*

JOB DESCRIPTION:

We have an exciting opportunity for a Workers' Compensation professional in our Phoenix, AZ location! If you have 2+ yrs experience handling medical claims, possess exceptional interpersonal, verbal and written communication skills, provide excellent customer service and are a team player, we want to see your resume.

POSITION SUMMARY:  Under close supervision manages all aspects of medical only and future medical only claims handling from inception to conclusion within established authority and guidelines. 

DUTIES AND RESPONSIBILITIES:

 Effectively manage a caseload of 150 medical files Initiate and conduct investigation in a timely manner Determine compensability of claims and administer benefits, based upon state law and in accordance with established  Company guidelines Manage medical treatment and medical billing, authorizing as appropriate Refer cases to outside defense counsel.  Direct and manage as appropriate Communicate with claimants, providers, and vendors regarding claim issues Compute and set reserves within Company guidelines Settle and finalize all claims and obtain authority as designated Maintain diary system for case review and document file to reflect the status and work being performed on the file Communicate appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns Involve TRISTAR loss control staff when appropriate Adhere to all Company policies and procedures Conduct file reviews independently Other duties as assigned

BENEFITS:  Excellent coverage for Medical, Dental and Vision. We offer 17 days of paid time off for Vacation, Personal Days, and one week of Jury Duty as well as 8 days of paid holidays. 401k with Company match, direct deposit, flextime, and more!

CONTACT INFORMATION:

Please fax or e-mail resume in MSWord format to: (714)648-0796 or e-mail to: jennifer.harabes@tristargroup.net.