Job Details
Level
Experienced
Job Location
Anchorage - Anchorage, AK
Position Type
Full Time
Education Level
High School Diploma or GED
Salary Range
$90,000.00 - $108,000.00 Salary
Travel Percentage
None
Job Shift
Job Category
Admin - Clerical
Workers' Compensation Claims Examiner III
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.
DUTIES AND RESPONSIBILITIES :
- Effectively manages a caseload of up to 135 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.*
- Refers cases to outside defense counsel. Directs and manages as appropriate.*
- Communicates with claimants, providers and vendors regarding claims issues.*
- Computes and set reserves within Company guidelines. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II.*
- Settles and / or finalize 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
Qualifications
QUALIFICATIONS REQUIRED :
Education / Experience : High School Diploma or GED required; Bachelor's degree in related field (preferred); five (4) years' experience handling and certified in Alaska.
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 to interact with persons at all levels in the business environment.
- Ability to independently and effectively manage very complex claims.
- Proficient in Word and Excel (preferred).
Other Qualifications :
- AK certification. Perferrably domiciled in Alaska
Workers' Compensation Claims Examiner III (Anchorage)
Workers' Compensation Claims Examiner III. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II. Effectively manages a caseload of up to 135 workers' compensation files, including very complex claims. This position requires considerable interaction with clients, claimant...
Claims Examiner - Workers Compensation
Description:PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices an...
Workers' Compensation Claims Examiner III (Anchorage)
Workers' Compensation Claims Examiner III. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II. Effectively manages a caseload of up to 135 workers’ compensation files, including very complex claims. This position requires considerable interaction with clients, claimant...
Workers' Compensation Claims Examiner II (Anchorage)
Workers' Compensation Claims Examiner II. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II. Effectively manages a caseload of up to 135 workers' compensation files, including very complex claims. Job LocationAnchorage - Anchorage, AK. ...
Workers' Compensation Claims Examiner II (Anchorage)
Workers' Compensation Claims Examiner II. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II. Effectively manages a caseload of up to 135 workers’ compensation files, including very complex claims. This position requires considerable interaction with clients, claimants...
Claims Examiner - Workers Compensation
Description:PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices an...
Workers' Compensation Claims Supervisor
Workers' Compensation Claims Supervisor. Directly: Claims Examiners, Claims Assistants; may supervise File/Mail Clerks and Administrative Assistants. This position requires considerable interaction with the client, management, other Claims Examiners, and other TRISTAR staff in the office; therefore,...
Data Reporting Analyst $74,300.00 - $106,100.00 per year
Implement changes to our infrastructure (optimize SQL queries and data workflows) to improve the landing time of our data. Experience in querying and analyzing and working with data languages and platforms to investigate large and diverse data sets. Architect data pipelines, design and build new das...
Project Manager II
Do you consider yourself to be a highly technical, strong communicator with the desire to work in a team environment on complex projects? Gilbane is seeking a Project Manager II to serve as the off-site Gilbane manager responsible for supporting the overall direction, completion and financial outcom...
Construction Cost Estimator
Our primary services include cost estimating, construction scheduling, life cycle cost analysis, cost control, operations and maintenance costs, quantity surveys, value engineering, and on-site construction progress inspections.These services include estimating all elements of construction, includin...