Claims Examiner I – Medical Only Adjuster Experience

TRISTAR Insurance Group

Claims Examiner managing a caseload of medical-only workers' compensation files. Collaborating with clients and claimants while adhering to established authority and guidelines.

Posted 6/30/2026full-timeRemote • Texas • 🇺🇸 United StatesJunior💰 $40,000 - $50,000 per yearWebsite

About the role

Key responsibilities & impact

Effectively manages a caseload of 150 to 180 workers’ compensation files.
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.
Communicates with claimants, providers, and vendors regarding claims issues.
Computes and sets reserves within Company guidelines.
Maintains a diary system for case review and document file to reflect the status of 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.
Adheres to all Company policies and procedures.
Participates in file reviews, as needed.

Requirements

What you’ll need

Minimum of one (1) year 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.
Proficient in Word and Excel (preferred).

Benefits

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Claims AdministrationCompensability DeterminationMedical TerminologyReserve ComputationDiary System Maintenance

Soft Skills

Interpersonal SkillsProblem-Solving