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 communicating effectively with various stakeholders. Proficient in statutory regulations, medical terminology, and claims management processes.

Highest-signal resume keywords

Indemnity Claims ManagementStatutory Regulations KnowledgeAnalytical SkillsExcellent Communication SkillsSIP Certification

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims InvestigationCompensability DeterminationMedical Treatment ManagementClaims SettlementFile ReviewSubrogation InvestigationReserve ComputationApportionment AssignmentState Audit AssistanceClaims Management

Soft Skills

MentoringInterpersonal SkillsIndependent Management

Tools & Technologies

Microsoft WordMicrosoft Excel

Certifications & Qualifications

SIP CertificationLicenses as Required by Jurisdiction

Industry Keywords

Indemnity ClaimsLitigated ClaimsTRISTAR Best PracticesMedical BillingClaims AdministrationWorkers' 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 compensability of claims and administer benefits based upon 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, and vendors regarding claims issues
Compute and set reserves within Company guidelines
Settle and/or finalize claims and obtain authority as designated
Maintain diary system and document files, including plans of action
Communicate information to clients to resolve claims efficiently, including injury trends and safety-related concerns
Conduct file reviews
Identify and review claims for Apportionment assignment
Identify and investigate subrogation potential and pursue recovery
Identify claim standard criteria for excess reporting and reimbursement
Assist with State Audit and reporting responses
Mentor less experienced Examiners
Perform other assigned duties, including claims management of 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
SIP is required for this position

Benefits

Comp & perks

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