TRISTAR Insurance Group

Claims Specialist

• Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority
• Initiates and conducts 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.
• Computes and set reserves within Company guidelines.
• Maintains diary system for case review and documents 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.
• Adheres to all Company policies and procedures.
• Conducts file reviews independently.
• Other duties as assigned.

Workers Compensation Claims Examiner III

Operator

• Answer and assist with all incoming calls, including first notice, and route them to the appropriate person or department.
• Manage a high-volume, multi-line telephone system effectively.
• Set up and enter new liability, subrogation, and first notice of loss reports in the claims/notice reporting systems or portals.
• Accurately document each call and its outcome in a clear, concise, and timely manner.
• Monitor dedicated client email inboxes for new first notice loss reports.
• Monitor phone lines and hold times, report excessive hold times to the supervisor for adjustment.
• Perform a variety of clerical duties as assigned.
• Maintain confidentiality and comply with HIPAA and PHI regulations.
• Use communication tools such as instant messaging, email, and Zoom to stay connected with team members and supervisors.

Telephonic Intake Operator

• Effectively manages a caseload of 150 or fewer workers’ compensation files, including complex claims.
• Initiates and investigates promptly.
• Determines compensability of claims and administers benefits based upon state law and following established Company guidelines.
• Manages medical treatment and medical billing, authorizing as appropriate.
• Refers cases to outside defense counsel. Directs and manages as appropriate.
• Communicates with claimants, providers, and vendors regarding claims issues.
• Computes and sets reserves within Company guidelines.
• Settles and finalizes all claims and obtains authority as designated.
• Maintains diary system for case review and documents file to reflect the status and work 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.
• Conducts file reviews independently.

• Manages all aspects of indemnity claims handling from inception to conclusion
• Effectively manages a caseload of 150 to 180 workers’ compensation files
• Initiates and conducts investigation in a timely manner
• Determines compensability of claims and administer benefits
• Manages medical treatment and medical billing
• Communicates with claimants, providers and vendors regarding claims issues
• Computes and set reserves within Company guidelines
• Settles and/or finalize all claims

Workers Compensation Claims Examiner III – Temp

Supervisor

• Provides oversight and leadership to a team of claims adjusters responsible for managing property, automobile, and liability claims from initial review through final resolution.
• Oversee policy interpretation and coverage determinations related to loss, damage, or injury, ensuring claims are investigated, evaluated, and resolved in an efficient, compliant, and cost-effective manner.
• Responsible for supervising adjusters handling large Self-Insured Retention (SIR) accounts and ensuring timely and accurate assessment of loss exposure, reserving practices, and settlement strategies.
• Ensures that claim developments, exposure evaluations, and strategic recommendations are effectively documented and clearly communicated to clients to support informed decision-making.

Property, Auto & Casualty Claims Supervisor

• 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

Workers' Compensation Claims Examiner III

Risk

• Provide safety and risk management consultation services to clients
• Develop tailored safety and risk prevention programs
• Conduct onsite or virtual safety and risk evaluations
• Collaborate with clients to enhance safety culture and compliance
• Create action plans for safety and risk management services

Safety and Risk Management Consultant

• Provide clients with onsite (and virtual) safety and risk management services.
• Create action plans for safety and risk management services, visiting (onsite or virtual) some clients several times per year.
• Evaluate the effectiveness of the client's hazard controls associated with their operations.
• Conduct high-level senior management professional business communications (presentations, emails, letters, in-person meetings, report writing, and telephone).

• Provides safety, risk, and loss control consultation services to clients.
• Develops tailored safety and risk prevention programs.
• Collaborates closely with clients to enhance their safety culture.
• Conducts loss control surveys onsite or virtually.
• Creates action plans for safety and risk management services.
• Leads the development, implementation, and evaluation of comprehensive safety programs.

Senior Safety and Risk Management Consultant

• Directly supervises examiners and clerical staff.
• Includes monitoring attendance, job performance, evaluations, and disciplinary issues.
• Reviews and addresses scheduled claims issues, such as initial and periodic reviews, delays, denials, etc.
• Reviews and approves reserve changes, awards, and payments within Company and Client guidelines.
• Performs file reviews to monitor compliance with policies and laws.
• Establishes appropriate supervisory diaries on claim files and completes pending diaries on or before scheduled due dates.
• Prepares for claim audits, reviews audit results, and provides appropriate rebuttal feedback.
• Coordinates and leads training sessions for staff on updated laws, policies, and procedures.
• Ensures daily caseload staffing requirements are met.
• Responds to claimant and vendor concerns and issues as needed.
• Ensures client servicing instructions are being adhered to.
• Analyzes monthly client reports.
• Facilitates internal and external audits.
• Attends client file-staffing meetings in-person or telephonically.

Workers' Compensation Claims Supervisor

Team Leader

• Under the oversight of the Area Manager, the Claims Examiner III – Team Leader reports to the Claim Supervisor and/or Area Manager and is responsible for managing all aspects of Auto Liability and PIP/No-Fault claims from inception through resolution
• Provides day-to-day guidance and technical support to Claims Examiners, ensuring consistency, quality, and adherence to best practices
• Helps to establish procedures for American Arbitration Association to help reduce costs and improve process
• Investigates and conducts investigations in a timely manner for claims assigned
• Communicates with clients, claimants, providers, and vendors regarding claims issues
• Computes and sets reserves within Company guidelines
• Approves authority requests of direct reports for claims assigned and directs them to obtain authority as designated
• Settles and/or finalizes all claims assigned and obtains authority as designated
• Maintains diary system for case review and documents file to reflect the status and work being performed on the file assigned
• Communicates appropriate information promptly to the Area Manager and client to resolve claims efficiently

Commercial Auto Liability, PIP/No Fault Team Leader

Support Engineer

• Manage and resolve support tickets within established response time targets.
• Maintain high ticket throughput while ensuring quality is not compromised.
• Strive for First Contact Resolution (FCR) to minimize user downtime and reduce escalation volume.
• Perform deep-dive technical troubleshooting to identify root causes of system issues.
• Ensure all escalations to Level 2 or developments are accurate and comprehensive, including: Clear reproduction steps, Detailed impact analysis, Severity levels and relevant system logs, Testing enhancements and bugs for monthly releases.

System Support Analyst

• Responsible for the prompt review of policy information including all relevant endorsements and vehicle schedules to determine coverage for loss/damage/injury.
• Conduct and efficient claim examination and investigation leading to the final resolution of liability claims, including matters in litigation.
• Frequent contact and interaction with involved parties including claimants and their legal representatives will be required.
• Recommendations regarding loss exposure and associated reserve and settlement strategy will be effectively communicated to the client.
• Review, process and conclude assigned claims including investigation and evaluation complex Commercial Auto and General Liability Casualty Claims.
• Review and interpret policies, coverage determination.
• Oversee and direct outside investigative service providers and work closely with the client and client counsel and investigative services to advance the claim to conclusion.
• Maintain an ongoing diary.
• Continually assess exposure and evaluate for accurate reserves and settlement recommendation.
• Prepare Loss Reports providing thorough analysis of liability and damages.
• Where applicable, determine if subrogation and/or risk transfer exists and initiate recovery efforts at the direction of the client.
• Document all correspondence, reports, discussions and decisions in the claim file record.
• Provide outstanding service to the client.
• Assist Supervisors and Claim Department with requested tasks or special projects.
• Other duties as assigned.

Commercial Auto Liability Claims Examiner III

Examiner

• Perform Workers Compensation, subrogation and recovery tasks within the claims handling guidelines and in accordance with established Best Practices.
• Identify subrogation opportunities through review of loss information and FNOL data.
• Place carriers on notice of subrogation.
• Perfect the lien and manage contact with claimants and their legal representatives.
• Obtain documents supporting subrogation from clients.
• Submit demands for subrogation.
• Affect subrogation recovery.
• Set reserves, post recoveries, track financial elements.
• Mentor team members pursuant to subrogation best practices to enhance technical knowledge and efficiency.
• Collaborate with leadership and legal counsel on litigation, arbitration, and mediation strategies.

Workers' Compensation Subrogation Examiner

• 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.

Workers Compensation Claims Examiner III

Telephonic Intake Operator

Workers Compensation Claims Examiner III

Workers Compensation Claims Examiner III – Temp

Property, Auto & Casualty Claims Supervisor

Workers' Compensation Claims Examiner III

Safety and Risk Management Consultant

Safety and Risk Management Consultant

Senior Safety and Risk Management Consultant

Workers' Compensation Claims Supervisor

Commercial Auto Liability, PIP/No Fault Team Leader

System Support Analyst

Commercial Auto Liability Claims Examiner III

Workers' Compensation Subrogation Examiner

Claims Examiner I – Medical Only Adjuster Experience