Workers Compensation Claims Examiner I

TRISTAR Insurance Group

. Manage an assigned medical-only workers’ compensation claims caseload .

Posted 10/24/2026full-timeMilwaukee • Wisconsin • United StatesJunior💰 $19 - $24 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in managing medical-only workers' compensation claims, including determining claim compensability, administering benefits, and maintaining accurate documentation. Proficient in communication with claimants, providers, and clients while adhering to statutory regulations and company guidelines.

Highest-signal resume keywords

Workers' Compensation Claims ManagementAdjuster's License (IN, MN, MI)Medical TerminologyAnalytical SkillsWritten and Verbal Communication

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims AdministrationBenefit DeterminationReserve ComputationDiary System MaintenanceMedical Billing Management

Soft Skills

Interpersonal SkillsAttention to DetailProblem-Solving Skills

Tools & Technologies

Microsoft WordMicrosoft Excel

Certifications & Qualifications

Adjuster's License

Industry Keywords

Statutory RegulationsClaim CompensabilityMedical Treatment AuthorizationClient CommunicationSafety Concerns

About the role

Key responsibilities & impact

Manage an assigned medical-only workers’ compensation claims caseload
Initiate and conduct 3-point contacts promptly according to Client and TRISTAR requirements
Determine claim compensability and administer benefits under state law and company guidelines
Manage medical treatment and billing, authorizing as appropriate
Refer claims to the Indemnity Examiner when they meet conversion qualifications
Communicate with claimants, providers, and vendors regarding claim issues
Compute and set reserves within company guidelines, with a $10,000 referral limit
Maintain the diary system and document files to reflect claim status and work performed
Communicate relevant information to clients, including injury trends and safety concerns
Adhere to company policies and procedures and perform other assigned duties

Requirements

What you’ll need

High School Diploma or GED required
Bachelor’s degree in a related field preferred
One (1) year or more related experience, or an equivalent combination of education and experience
Must have an active IN, MN, or MI adjuster’s license or a license in a state with reciprocity
Technical understanding of statutory regulations and medical terminology
Analytical skills
Excellent written and verbal communication skills, including conveying technical details to claimants, clients, and staff
Ability to interact with persons at all levels in the business environment
Proficiency in Word and Excel preferred
Ability to perform light work and associated physical activities, including standing, walking, lifting, reaching, fingering, grasping, talking, and hearing
Ability to perform required visual and repetitive-motion tasks