POSITION SUMMARY: Under minimal supervision manages all aspects of indemnity and medical claims 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 therefore; consistently being available during established work hours is inherently required of this position.

DUTIES AND RESPONSIBILITIES:
Responsibilities include but aren’t limited to the following:

• Effectively manage a full caseload of 140+ claims with varying degrees of complexity in accordance with applicable State WC Laws and Statutes.

• Initiate and conduct thorough claims investigation, including recorded statements, in a timely manner.]
• Determine compensability of claims and administer appropriate WC benefits in accordance with applicable State WC Laws and Statutes as well as; applicable TRM Claims Management Policies & Procedures, TRM Best Practices, and any applicable client claims handling instructions / policies & procedures.
• Manage medical treatment and medical billing as appropriate.
• Evaluate appropriateness of Independent Medical Evaluations when necessary.
• Evaluate and manage appropriate and timely payment of indemnity WC benefits, i.e. TTD, TPD, PTD, PPI, and Voc Rehab.
• Engage and effectively communicate with assigned defense counsel on all claims involving on-going litigation. Ensure appropriate legal referrals have been completed.
• Regular communication with internal administrative staff, injured workers, medical providers, client representatives and legal staff required.
• Maintain a diary / task based claims system for timely claim review and claims system document management.
• Manage and note claim file in accordance with TRM Claim Management Policies & Procedures and TRM Best Practices.
• Effectively evaluate and reserve the claim to reflect most probable outcome from a financial perspective.

• Other duties as assigned.

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EQUIPMENT OPERATED/USED: *Computer, 10-key, fax machine, copier, printer, and other office equipment.

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SPECIAL EQUIPMENT OR CLOTHING: *Appropriate office attire when participating in virtual or in-person meetings.
QUALIFICATIONS REQUIRED:

Education/Experience: Bachelor’s degree in related field (preferred); three (3) or more years related experience; or equivalent combination of education and experience.

Knowledge, Skills and Abilities:

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3+ years WC claims handling experience:*

• 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:

• Must have valid State of Indiana, Michigan or Minnesota Adjuster License. If all other qualifications are met, will consider accepting a license from another State as long as that license will have reciprocity in the States requiring licensing with the Branch jurisdictions.

Location: 20935 Swenson Drive,Suite 300, Waukesha, WI 53186

Job Type: Full-time

Pay: $58,000.00 - $70,000.00 per year

Schedule:

• 8 hour shift

Work Location: Remote

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