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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 workers’ compensation files, including 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.
Education/Experience: High School Diploma or GED required; Bachelor’s degree in related field (preferred); three (3) years of industry experience or equivalent combination of education and experience; five (5) years’ experience handling WA and OR claims; experience working with Self insured clients
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).
- WA and/or OR certification
Embrace Excellence! We believe that no one should ever come to work with thoughts of spending the day mired in mediocrity. The City of Seattle's Compensation and Classification team is experiencing an exciting transformation where operational excellence and service is the expectation, standard and culture. We are currently seeking a highly energized, highly skilled, individual to share in this experience by joining our team as a Classification/Compensation Analyst in the City's centralized Human Resource Department (SDHR). If you would like to contribute to this evolution, please read on for more information.Job Responsibilities
To be successful, you will have a good foundation in:
• The technical aspects of classification and compensation work
• Critical thinking and analysis
• Professional level writing and oral communication
Are you a skilled Workers' Compensation Analyst looking for an organization that takes a more human approach to claims adjusting? Do you have hands-on adjusting experience with Washington Workers' Compensation Self-Insurance? Would you like to work in a customer-focused team environment where work/life balance and reasonable case loads (130 on average) are the norm? If so, please read on for more information about this opportunity.Job Responsibilities
Your success in this role will depend on the following:
• Knowledge of workers' compensation claims handling and management, pertinent guidelines and laws, as well as medical services and terminology
• Judgment and decision-making throughout the stages of the claims process
• Planning and coordination of each claim and the steps and stakeholders involved
• Communication with a wide variety of people and perspectives, including situations that require confidence and defense of both your preparation and decision-making
• Monitoring claims progress as well as work of consultants
• Accuracy in estimation of claim reserves needed and calculation of wage replacement benefits
• Initiative and accountability