Workers Compensation Claims Examiner III

TRISTAR Insurance Group

Claims Examiner managing all aspects of indemnity claims handling at TRISTAR. Requires extensive client interaction and independent case management in Houston, TX.

Posted 6/30/2026full-timeHouston • Texas • 🇺🇸 United StatesMid-LevelSenior💰 $75,000 - $83,000 per yearWebsite

About the role

Key responsibilities & impact

Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority
Initiates and conducts investigation in a timely manner.
Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.
Manages medical treatment and medical billing, authorizing as appropriate.
Communicates with claimants, providers and vendors regarding claims issues.
Computes and set reserves within Company guidelines.
Maintains diary system for case review and documents file 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 independently.
Other duties as assigned.

Requirements

What you’ll need

High School Diploma or GED required
Bachelor’s degree in related field (preferred);
Five (5) or more years related experience;
Technical knowledge of statutory regulations and 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.
Proficient in Word and Excel (preferred).
Texas Workers Compensation License

Benefits

Comp & perks

Medical, Dental & Vision Insurance
Life & Disability Insurance
401(k) plan
Paid time off
Paid holidays.

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Claims HandlingCompensability DeterminationMedical Billing ManagementReserve ComputationFile Review

Soft Skills

Interpersonal SkillsIndependent Management

Certifications

Texas Workers Compensation License