Claims Examiner II/III temporary - TRISTAR Insurance Group, Inc (sacramento/rancho cordova,
Posted: Sunday, September 3, 2017 10:13 AM
POSITION SUMMARY: Under supervision, manages all aspects of indemnity and future medical 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. This position is a CIGA:dedicated position. CIGA is the California Insurance Guarantee Association which is a quasi:governmental agency which handles claims from insurance carriers that have gone into liquidation.DUTIES AND RESPONSIBILITIES:Effectively manages a caseload of 130 to 150 workersA? compensation files, including very complex claims. All files are CIGA files.*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/Client 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.*Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.*Adheres to all Company policies and procedures.*Conducts file reviews independentlyOther duties as assigned.* Essential job function.QUALIFICATIONS REQUIRED:Education/Experience: BachelorA?s degree in related field (preferred); three (3) 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:Certifications and/or licenses as required by State regulation.CIGA experience a plus.
• Location: Sacramento, sacramento/rancho cordova
• Post ID: 18495687 sacramento