Workers Compensation Claims Examiner III

TRISTAR Insurance Group

Workers Compensation Claims Examiner managing all aspects of indemnity claims handling. Engaging with clients and claimants while adhering to established authority in a remote position.

Posted 6/30/2026full-timeRemote • Wisconsin • 🇺🇸 United StatesMid-LevelSenior💰 $70,000 - $85,000 per yearWebsite

About the role

Key responsibilities & impact

Effectively manages a caseload of 150 or fewer workers’ compensation files, including complex claims.
Initiates and investigates promptly.
Determines compensability of claims and administers benefits based upon state law and following established Company guidelines.
Manages medical treatment and medical billing, authorizing as appropriate.
Refers cases to outside defense counsel. Directs and manages as appropriate.
Communicates with claimants, providers, and vendors regarding claims issues.
Computes and sets reserves within Company guidelines.
Settles and finalizes all claims and obtains authority as designated.
Maintains diary system for case review and documents file to reflect the status and work performed on the file.
Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety-related concerns.
Involves TRISTAR loss control staff when appropriate.
Adheres to all Company policies and procedures.
Conducts file reviews independently.

Requirements

What you’ll need

Bachelor’s degree in a related field (preferred)
Three (3) or more years of related experience; or equivalent combination of education and experience.
WC Adjuster’s license for MI & MN preferred but will also consider an adjuster's license for TX, FL & Indiana
Technical knowledge of statutory regulations and medical terminology.
Analytical skills.
Excellent written and verbal communication skills, including conveying technical details to claimants, clients, and staff.
Ability to independently and effectively manage very complex claims.
Proficient in Word and Excel (preferred).

Benefits

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Claims InvestigationCompensability DeterminationMedical Treatment ManagementReserves ComputationFile ReviewClaims SettlementDiary System Maintenance

Soft Skills

Independent ManagementEffective Communication

Certifications

WC Adjuster's License for MI & MNAdjuster's License for TX, FL & Indiana