Claims Examiner III

TRISTAR Insurance Group

Claims Examiner III managing all aspects of indemnity claims for TRISTAR. Requires bachelor’s degree and 1-5 years experience in insurance claims.

Posted 6/30/2026full-timeFresno • California • 🇺🇸 United StatesJunior💰 $35 - $43 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing indemnity claims, including complex workers' compensation cases, while ensuring compliance with statutory regulations and effective communication with all stakeholders. Proficient in claims investigation, medical treatment management, and analytical problem-solving.

Highest-signal resume keywords

Indemnity Claims ManagementWorkers' Compensation ExpertiseClaims InvestigationAnalytical SkillsExcellent Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims HandlingCompensability DeterminationMedical Billing ManagementReserve ComputationCase Review Management

Soft Skills

Interpersonal SkillsIndependent ManagementProblem-Solving

Tools & Technologies

Microsoft WordMicrosoft Excel

Certifications & Qualifications

State Certification or License

Industry Keywords

Statutory RegulationsMedical TerminologyClaims Examiner

About the role

Key responsibilities & impact

Under general supervision, manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.
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 administers benefits, based upon state law and in accordance with established Company guidelines.
Manages medical treatment and medical billing, authorizing as appropriate.
Refers cases to outside defense counsel as appropriate. Monitors legal aspects.
Communicates with claimants, providers, and vendors regarding claims issues.
Computes and sets reserves within Company guidelines. Limits are less than those allowed for Claims Examiner III, but larger than those for Claims Examiner I.
Settles and/or finalizes all claims and obtains authority as designated.
Maintains a diary system for case review and document 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.
Involves TRISTAR loss control staff when appropriate.

Requirements

What you’ll need

Bachelor’s degree in related field (preferred); and one (1) to five (5) years related experience; or equivalent combination of education and experience.
Technical knowledge of statutory regulations and medical terminology.
Analytical skills.
Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
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).
Certification and/or license as required by State regulation.

Benefits

Comp & perks

Medical, Dental, Vision Insurance.
Life and Disability Insurance.
401(k) Plan
Paid Holidays
Paid Time Off.
Referral bonus.