Claims Examiner III

TRISTAR Insurance Group

. Manage all aspects of complex and litigated indemnity claims from inception to conclusion within established authority and guidelines .

Posted 9/22/2026full-timeRancho Cordova • California • United StatesMid-LevelSenior💰 $90,000 - $95,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing complex and litigated indemnity claims, including conducting investigations, determining compensability, and adhering to statutory regulations. Proficient in communication and collaboration with various stakeholders while mentoring less experienced team members.

Highest-signal resume keywords

Indemnity Claims ManagementStatutory Regulations KnowledgeAnalytical SkillsExcellent Communication SkillsClaims Investigation

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdministrationCompensability DeterminationMedical Treatment ManagementReserve ComputationSubrogation Investigation

Soft Skills

MentoringInterpersonal SkillsIndependent Management

Tools & Technologies

Microsoft WordMicrosoft ExcelOffice Equipment Usage

Certifications & Qualifications

Licenses as Required by Jurisdiction

Industry Keywords

Litigated ClaimsTRISTAR Best PracticesMedical TerminologyClaims ApportionmentWorkers’ Compensation

About the role

Key responsibilities & impact

Manage all aspects of complex and litigated indemnity claims from inception to conclusion within established authority and guidelines
Manage a caseload of indemnity claim files, including very complex and litigated claims
Initiate and conduct timely investigations
Determine claim compensability and administer benefits based on state law and TRISTAR Best Practices
Manage medical treatment and medical billing, authorizing as appropriate
Refer cases to outside defense counsel and participate in litigated matters
Communicate with claimants, attorneys, providers, vendors, clients, and staff regarding claims issues
Compute and set reserves within Company guidelines
Settle and/or finalize claims and obtain designated authority
Maintain diary systems, document files, and create plans of action
Conduct client and management file reviews
Identify and review claims for apportionment assignment
Investigate subrogation potential and pursue recovery
Identify claim standards for excess reporting and reimbursement
Assist with state audit and reporting responses
Mentor less experienced Examiners
Perform other assigned duties, including claims management for other jurisdictional workers’ compensation claims
Adhere to TRISTAR company policies and procedures

Requirements

What you’ll need

Minimum of five (5) or more years of related experience, or an 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)
Licenses as required by Jurisdiction
Ability to use a computer, 10-key, fax machine, copier, printer, and other office equipment

Benefits

Comp & perks

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