This is a Hybrid position at our Rancho Cordova, CA branch.  Please sign the application at the end.

CA SIP License is required.

POSITION SUMMARY:  At the Direction of the Claims Supervisor, manages all aspects of indemnity and future medical claims from inception to conclusion within established authority and guidelines.  This position requires considerable interaction with clients, claimants, medical providers, Vendors, and other TRISTAR staff in the office.  

 

 

DUTIES AND RESPONSIBILITIES:

Effectively manages a caseload of 130 to 150 workers’ compensation files, including complex claims. * Initiates and conducts investigations in a timely manner.* Determines compensability of claims and administers benefits, based upon state laws/Rules 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. * Communicate with claimants, providers, and vendors regarding claims issues. * Computers and sets reserves within Company/Client guidelines. * Settles and/or finalizes all claims and obtains authority as designated. * Maintains a diary system for case review and document files 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. * Adheres to all Company policies and procedures. * Conducts file reviews Adheres to agreed client handling instructions Other duties as assigned.

 

Essential job function.

 

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

 

SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire.