Workers' Compensation Claims Examiner III

TRISTAR Insurance Group

Workers’ Compensation Claims Examiner managing indemnity claims for TRISTAR. Interacting with clients and handling complex claims investigations in a timely manner.

Posted 6/30/2026full-timeFresno • California • 🇺🇸 United StatesMid-LevelSenior💰 $84,000 per yearWebsite

About the role

Key responsibilities & impact

Effectively manages a caseload of 150 to 180 workers’ compensation files, including complex claims
Initiates and conducts claims 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

Requirements

What you’ll need

Bachelor’s degree in related field (preferred)
One (1) to five (5) years related experience; or equivalent combination of education and experience
Technical knowledge of statutory regulations and medical terminology
Excellent written and verbal communication skills
Proficient in Word and Excel (preferred)

Benefits

Comp & perks

Health insurance
Retirement plans
Paid time off

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Claims AdministrationCompensability DeterminationMedical Billing AuthorizationTechnical Knowledge of Medical TerminologyCase Management

Soft Skills

Written CommunicationVerbal Communication