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:

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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 set reserves within Company guidelines.*
• 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, 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.*
• Assist with State Audit and reporting responses.*
• Other duties as assigned and including claims management of other jurisdictional workers’ comp claims.
• Adheres to all TRISTAR company policies and procedures.*

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QUALIFICATIONS REQUIRED:*
Education/Experience: Bachelor’s degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience. Workers Compensation claims experience for the State of Colorado, preferred.
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).
• Knowledge of self-insured claims handling (preferred).
• City, County and/or District claims handling experience (preferred).

Other Qualifications:

• Nevada Adjuster’s License required and work in State

Location: 2950 E. Rochelle Ave, Las Vegas, NV 89121

Job Type: Full-time

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