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This is a hybrid position but can be remote eligible if residing in Maryland. 

This will be a position handling  Workers' Compensation claims for predominantly Maryland jurisdiction.   Must have experience handling these claims.

 

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:

 

Remote or Hybrid position. Effectively manages a caseload of 125 to 150 workers’ compensation files, including very complex claims.* Jurisdictions is MD.* Initiates and conducts investigations 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 finalizes 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.* Conduct file reviews independently.* Other duties as assigned.

* Essential job function.

 

 

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

 

 

SPECIAL EQUIPMENT OR CLOTHING:  Appropriate business casual office attire