Worker Compensation Claims Examiner III

TRISTAR Insurance Group

Worker Compensation Claims Examiner managing complex indemnity claims for TRISTAR. Handling investigations, benefits administration, and communication with all stakeholders in the claims process.

Posted 6/30/2026full-timeRemote • Texas • 🇺🇸 United StatesMid-LevelSenior💰 $60,000 - $75,000 per yearWebsite

About the role

Key responsibilities & impact

Manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines
Effectively manages a caseload of 150 workers’ compensation files
Initiates and conducts investigations in a timely manner
Determines compensability of claims and administers benefits
Manages medical treatment and billing
Refers cases to outside defense counsel and directs as appropriate
Communicates with claimants, providers and vendors regarding claims issues
Computes and sets reserves within Company guidelines
Settles and/or finalizes all claims
Maintains diary system for case review and documents file status
Communicates appropriate information promptly to the client

Requirements

What you’ll need

Bachelor’s degree in related field (preferred)
Three (3) or more years related experience
Technical knowledge of statutory regulations and medical terminology
Analytical skills
Excellent written and verbal communication skills
Ability to independently and effectively manage very complex claims
Proficient in Word and Excel (preferred)
Texas Workers Compensation License

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 HandlingCompensability DeterminationMedical Treatment ManagementCase ReviewReserves Computation

Soft Skills

Analytical SkillsEffective Management

Certifications

Texas Workers Compensation License