Claims Examiner III (Hybrid)

Job description

Job DetailsLevel: ExperiencedJob Location: Sacramento - Rancho Cordova, CA 95670Position Type: Full TimeSalary Range: $80,000.00 - $99,000.00 SalaryJob Shift: DayJob Category: InsuranceThis will be a permanent Floating Examiner position to cover open desks due to Vacations, Leaves of Absence, new business onboarding, increased pending inventories, Auditing, etc. SIP Must: At the Direction of the Claims Supervisor and/or Manager, under minimal supervision, manages all aspects of Workers’ Compensation claims (complex, litigated, non-disabling) claims from inception to conclusion within established authority and guidelines. The position requires considerable interaction with clients, claimants, medical providers, Attorneys, vendors, Nurse and Vocational Case Managers, and other TRISTAR staff. DUTIES AND RESPONSIBILITIES: Effectively manages a Temporary caseload of Workers’ Compensation claim files, including very complex and litigated claims. * Initiates and conducts investigations in a timely manner. * Determines compensability of claims and administers benefits based upon state law and TRISTAR Best Practices for claim handling. * Manages medical treatment and medical billing, author...