Workers' Compensation Claims Examiner I

TRISTAR Insurance Group

. Manage all aspects of medical-only claims handling from inception to conclusion within established authority and guidelines .

Posted 10/24/2026full-timeCorpus Christi • Texas • United StatesJunior💰 $25 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing medical-only claims, including conducting investigations, determining compensability, and administering benefits in compliance with state laws and company guidelines. Proficient in communication and analytical skills to effectively manage a caseload and resolve claims efficiently.

Highest-signal resume keywords

Medical Claims ManagementWorkers’ Compensation ExpertiseClaims InvestigationStatutory Regulations KnowledgeAnalytical Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims HandlingCompensability DeterminationMedical Billing ManagementReserve ComputationDiary System MaintenanceArithmetic CalculationsTranscriptionDocument Review

Soft Skills

Excellent Written CommunicationExcellent Verbal CommunicationInterpersonal SkillsProblem-Solving Skills

Tools & Technologies

Microsoft WordMicrosoft Excel

Industry Keywords

Medical TerminologyWorkers’ CompensationClaims AdministrationLoss ControlCompany Policies

About the role

Key responsibilities & impact

Manage all aspects of medical-only claims handling from inception to conclusion within established authority and guidelines
Effectively manage a caseload of 150 to 180 workers’ compensation files
Initiate and conduct claims investigations in a timely manner
Determine compensability of claims and administer benefits based on state law and Company guidelines
Manage medical treatment and medical billing, authorizing as appropriate
Communicate with claimants, providers, and vendors regarding claims issues
Compute and set reserves within Company guidelines
Maintain diary systems for case review and document files reflecting file status and work performed
Communicate information promptly to clients to resolve claims efficiently, including injury trends and safety-related concerns
Involve TRISTAR loss control staff when appropriate
Adhere to Company policies and procedures
Participate in file reviews as needed
Perform other duties as assigned

Requirements

What you’ll need

Minimum of one (1) year of 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)
Ability to follow written, verbal, or diagrammatic instructions
Ability to solve practical problems and interpret instructions
Arithmetic calculations involving fractions, decimals, and percentages
Ability to transcribe dictation, make appointments, process mail, write routine correspondence, and interpret written work instructions
Ability to perform light work and associated physical activities including stooping, kneeling, crouching, reaching, standing, walking, pushing, pulling, lifting, fingering, grasping, talking, hearing, and repetitive wrist, hand, and finger motions

Benefits

Comp & perks

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