Workers' Compensation Claims Examiner III (Anchorage)

Job Details

Level
Experienced

Job Location
Anchorage - Anchorage, AK

Remote Type
Hybrid

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
Day

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