Workers Compensation Claims Examiner II

TRISTAR Insurance Group

Claims Examiner II managing a caseload of workers’ compensation claims for TRISTAR. Initiating investigations and determining compensability while adhering to guidelines and communicating with clients.

Posted 6/30/2026full-timeRemote • Wisconsin • 🇺🇸 United StatesMid-LevelSenior💰 $50,000 - $70,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing workers' compensation claims, including determining compensability, managing medical treatment, and adhering to statutory regulations. Strong analytical and communication skills are essential for effective interaction with claimants, providers, and vendors.

Highest-signal resume keywords

Workers' Compensation Claims ManagementStatutory Regulations KnowledgeMedical Terminology ProficiencyAnalytical SkillsExcellent Written And Verbal Communication

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdministrationCompensability DeterminationMedical Treatment ManagementReserves ComputationFile Review Conducting

Soft Skills

Interpersonal SkillsIndependent ManagementProblem-Solving Skills

Tools & Technologies

Microsoft WordMicrosoft Excel

Industry Keywords

Workers' CompensationClaims ProcessingMedical BillingDiary System Maintenance

About the role

Key responsibilities & impact

Effectively manages a caseload of 150 or fewer workers’ compensation files
Initiates and investigates promptly
Determines compensability of claims and administers benefits based upon state law
Manages medical treatment and medical billing, authorizing as appropriate
Communicates with claimants, providers, and vendors regarding claims issues
Computes and sets reserves within Company guidelines
Maintains diary system for case review
Communicates appropriate information promptly to the client to resolve claims efficiently
Adheres to all Company policies and procedures
Conducts file reviews as scheduled by the client and management

Requirements

What you’ll need

High school diploma or GED required
Bachelor’s degree in a related field (preferred)
Three (3) or more years of 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 fairly complex claims
Proficient in Word and Excel (preferred)

Benefits

Comp & perks

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