Workers compensation claims examiner i / medical only

Job Details:

• Job Location: Honolulu - Kapolei, HI
• Position Type: Full Time
• Education Level: High School Diploma or GED
• Salary Range: $28.84 - $36.05 Hourly
• Travel Percentage: None
• Job Shift: Day
• Job Category: Admin - Clerical

POSITION SUMMARY: At the direction of the Claims Supervisor (or designated CE III Mentor) manages all aspects of Medical Only claims from inception to conclusion within established authority and guidelines. Once proficiency is established, additional responsibilities will include handling minor lost time and future medical claims. This position requires considerable interaction with clients, claimants, Providers, Claims Examiners, and other TRISTAR staff. Therefore, consistently being at work in the office or home office location as applicable, in a timely manner, is inherently required of this position.

DUTIES AND RESPONSIBILITIES:

• Effectively manages a caseload of 150 to 200 workers’ compensation files.
• Initiates and conducts claims investigations in a timely manner.
• Medical only; indemnity transition. Determines compensability of claims and administers benefits, based upon state laws and rules and in accordance with established Company guidelines.
• Manages medical treatment and medical billing, authorizing as appropriate, with requests for surgical treatment to be referred to supervisor before authorizing.
• Communicates with claimants, providers, and vendors regarding claims issues.
• Computes and sets reserves within Company guidelines, up to $*****.
• Finalizes all claims and obtains authority as designated.
• Maintains diary system for case review and document file to reflect the status of 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 designated loss control staff when appropriate.
• Adheres to all Company policies and procedures.
• Participate in file reviews, as needed. Other duties as assigned include assisting as a claims assistant.

Essential job function.

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

SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire

Qualifications:

QUALIFICATIONS REQUIRED:

• Education/Experience: Bachelor’s degree in related field (preferred); and one (1) year 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. Proficient in Word and Excel (preferred).
• Other Qualifications: Certification and/or or license as required by State regulation.

Mental and Physical Requirements:

[see separate attachment for a copy of the checklist of mental and physical requirements]