Workers' Compensation Claims Examiner I - Medical Only

TRISTAR Insurance Group

. Manage workers’ compensation medical-only claims from inception through resolution, with total exposure not exceeding $10,000 and within assigned authority limits .

Posted 10/3/2026full-timeIrving • Texas • United StatesJunior💰 $24 - $26 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing workers' compensation medical-only claims, including conducting investigations, determining compensability, and coordinating medical treatment. Proficient in analyzing claim information and maintaining accurate documentation while effectively communicating with various stakeholders.

Highest-signal resume keywords

Workers' Compensation Claims ManagementClaim InvestigationMedical Billing CoordinationAnalytical SkillsEffective Communication

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claim DocumentationCompensability DeterminationReserve CalculationMedical TerminologyStatutory Requirements

Soft Skills

Organizational SkillsProfessional InteractionTask PrioritizationDeadline Management

Tools & Technologies

Microsoft WordMicrosoft Excel

Certifications & Qualifications

State Certification or License

Industry Keywords

Workers' Compensation LawsMedical-Only ClaimsClaim ExposureIndemnity BenefitsSafety Concerns

About the role

Key responsibilities & impact

Manage workers’ compensation medical-only claims from inception through resolution, with total exposure not exceeding $10,000 and within assigned authority limits
Initiate and conduct timely claim investigations
Determine compensability in accordance with applicable state laws and company guidelines
Coordinate and monitor medical treatment and medical billing
Communicate with claimants, employers, medical providers, vendors, clients, and TRISTAR staff
Calculate, establish, and adjust reserves within assigned authority and company guidelines
Monitor claims for lost time, potential indemnity benefits, increased medical exposure, litigation, or other developments
Refer claims exceeding $10,000 or the medical-only scope to a supervisor
Maintain a diary system and accurate claim documentation
Communicate injury trends and safety concerns to clients
Participate in file reviews and perform other assigned duties

Requirements

What you’ll need

High school diploma or GED
One to three years of related experience
Working knowledge of applicable workers’ compensation laws, statutory requirements, and relevant medical terminology
Ability to investigate and manage medical-only claims within assigned authority and established guidelines
Analytical skills to evaluate claim information, medical documentation, and billing
Ability to recognize changes in claim exposure or complexity and promptly seek supervisory guidance
Strong organizational skills; ability to maintain a diary system, prioritize tasks, and meet deadlines
Effective written and verbal communication skills
Ability to interact professionally with individuals at all levels of the business environment
Proficiency in Microsoft Word and Excel preferred
Certification and/or license as required by state regulation
Ability to perform sedentary work and meet stated mental, visual, and physical requirements