Address
Form of workJob Details
Level
Experienced
Job Location
Phoenix Office - Phoenix, AZ
Remote Type
Hybrid
Position Type
Full Time
Education Level
High School Diploma or GED
Salary Range
$70,000.00 - $77,000.00 Salary
Travel Percentage
None
Job Shift
Day
Job Category
Insurance
Claims Examiner III - hybrid
PLEASE SIGN THE APPLICATION AT THE END - THIS IS A HYBRID POSITION, LIVING LOCALLY, ARIZONA ADJUSTER LICENSE PREFERRED
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. (Hybrid in/out of office, depending on requirements for the office) DUTIES AND RESPONSIBILITIES:• Effectively manages a caseload of indemnity claim files, including very complex and litigated claims.*• Initiates and conducts investigation in a timely manner.*• Determines compensability of claims and administer benefits based upon state law and TRISTAR Best Practices for claim handling.*• Manages medical treatment and medical billing, authorizing as appropriate.*• Refers cases to outside defense counsel and participates in litigated matters.*• Communicates with claimants, attorneys, providers and vendors regarding claims issues.*• Work in an organized and proactive manner.*• Computes and sets reserves within Company guidelines.*• 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, including a plan of action.*• Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety-related concerns.*• Conducts file reviews as scheduled by the client and management.*• Identify and review claims for Apportionment assignment.*• Identify and investigate subrogation potential and pursue recovery.*• Identify claim standard criteria for excess reporting and reimbursement.*• Other duties as assigned.*• Adheres to all TRISTAR company policies and procedures.*
Qualifications
PLEASE SIGN THE APPLICATION AT THE END - THIS IS A HYBRID POSITION, LIVING LOCALLY, ARIZONA ADJUSTER LICENSE PREFERRED
Education/Experience: Minimum five (5) or more years related experience; or equivalent combination of education and experience. 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: Arizona Adjuster's License preferred.
Level
Experienced
Job Location
Phoenix Office - Phoenix, AZ
Remote Type
Hybrid
Position Type
Full Time
Education Level
High School Diploma or GED
Salary Range
$70,000.00 - $77,000.00 Salary
Travel Percentage
None
Job Shift
Day
Job Category
Insurance
Claims Examiner III - hybrid
PLEASE SIGN THE APPLICATION AT THE END - THIS IS A HYBRID POSITION, LIVING LOCALLY, ARIZONA ADJUSTER LICENSE PREFERRED
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. (Hybrid in/out of office, depending on requirements for the office) DUTIES AND RESPONSIBILITIES:• Effectively manages a caseload of indemnity claim files, including very complex and litigated claims.*• Initiates and conducts investigation in a timely manner.*• Determines compensability of claims and administer benefits based upon state law and TRISTAR Best Practices for claim handling.*• Manages medical treatment and medical billing, authorizing as appropriate.*• Refers cases to outside defense counsel and participates in litigated matters.*• Communicates with claimants, attorneys, providers and vendors regarding claims issues.*• Work in an organized and proactive manner.*• Computes and sets reserves within Company guidelines.*• 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, including a plan of action.*• Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety-related concerns.*• Conducts file reviews as scheduled by the client and management.*• Identify and review claims for Apportionment assignment.*• Identify and investigate subrogation potential and pursue recovery.*• Identify claim standard criteria for excess reporting and reimbursement.*• Other duties as assigned.*• Adheres to all TRISTAR company policies and procedures.*
Qualifications
PLEASE SIGN THE APPLICATION AT THE END - THIS IS A HYBRID POSITION, LIVING LOCALLY, ARIZONA ADJUSTER LICENSE PREFERRED
Education/Experience: Minimum five (5) or more years related experience; or equivalent combination of education and experience. 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: Arizona Adjuster's License preferred.
