POSITION SUMMARY:  At the direction of the Claims Supervisor (or designated CE III Mentor) manages all aspects of Medical Only claims from inception to conclusion within established authority and guidelines.  Once proficiency is established, additional responsibilities will include handling minor lost time and future medical claims.

This position requires considerable interaction with clients, claimants, Providers, Claims Examiners, and other TRISTAR staff.  Therefore consistently being at work in the office or home office location as applicable, in a timely manner, is inherently required of this position.

 

DUTIES AND RESPONSIBILITIES:

Effectively manages a caseload of 150 to 200 workers’ compensation files.* Initiates and conducts claims investigation in a timely manner.* Medical only, indemnity transition. Determines compensability of claims and administers benefits, based upon state laws and rules and in accordance with established Company guidelines.* Manages medical treatment and medical billing, authorizing as appropriate, with requests for surgical treatment to be referred to supervisor prior to authorizing. * Communicates with claimants, providers and vendors regarding claims issues.* Computes and set reserves within Company guidelines, up to $*****. * Finalizes all claims and obtains authority as designated.* Maintains diary system for case review and document file to reflect the status of 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 designated loss control staff when appropriate.* Adheres to all Company policies and procedures.* Participates in file reviews, as needed. Other duties as assigned include assisting as a claims assistant.  *Essential job function.

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

SPECIAL EQUIPMENT OR CLOTHING:  Appropriate office attire

Other duties as assigned