Workers Compensation Claims Examiner III (Hybrid)
$85,000–$95,000 year
HybridSacramento, California, United States or Rancho Cordova, California, United States
Job Summary
Manage complex and litigated indemnity claims from inception to conclusion under established authority and guidelines. Initiate investigations, determine compensability, and administer benefits based on state law and TRISTAR Best Practices. Authorize medical treatment, compute reserves, and settle claims while pursuing subrogation recovery. Communicate with claimants, attorneys, and vendors to resolve issues efficiently, conduct file reviews, and mentor less experienced staff. Maintain organized diaries and document case status for client reporting. This hybrid, temp-to-hire role at TRISTAR requires considerable interaction with external parties and adherence to company policies.
Required Qualifications
- Minimum five (5) or more years of related experience
- Technical knowledge of statutory regulations
- Medical terminology
- Analytical skills
- Excellent written and verbal communication skills
- Ability to interact with persons at all levels in the business environment
- Ability to independently and effectively manage very complex claims
- Licenses as required by jurisdiction
- SIP is required
- Hybrid work arrangement
- Temp-to-hire opportunity
- Reasoning development: Solve practical problems; variety of variables with limited standardization; interpret instructions
- Logical or scientific thinking to solve problems; several abstract and concrete variables
- Arithmetic calculations involving fractions, decimals, and percentages
- Ability to transcribe dictation
- Ability to make appointments and process mail
- Ability to write form letters or routine correspondence
- Ability to interpret written work instructions
- Ability to interview job applicants
- Near vision: clarity of vision at 20 inches or less
- Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet
- Depth perception: the ability to judge distance and space relationships
- Color vision: ability to identify and distinguish colors
- Field of vision: ability to observe an area up or down or to the right or left
- Stooping
- Kneeling
- Crouching
- Reaching
- Standing
- Walking
- Pushing
- Pulling
- Lifting
- Fingering
- Grasping
- Talking
- Hearing
- Repetitive Substantial movements (motions) of the wrists, hands, and/or fingers
Desired Qualifications
- Proficient in Word and Excel
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