Workers' Compensation Claims Examiner I – Medical Only

TRISTAR Insurance Group

. Manage workers’ compensation medical-only claims from inception through resolution, with total claim 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

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

Demonstrates expertise in managing workers' compensation medical-only claims, including conducting investigations, evaluating claims, and adhering to state laws and company guidelines. Proficient in communication and organization, ensuring timely case management and accurate documentation.

Highest-signal resume keywords

Workers' Compensation Claims ManagementMedical TerminologyAnalytical SkillsEffective CommunicationOrganizational Skills

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 EvaluationInvestigation TechniquesMedical Billing CoordinationReserve CalculationDiary System Maintenance

Soft Skills

Strong Organizational SkillsEffective Written CommunicationProfessional Interaction

Tools & Technologies

Microsoft WordMicrosoft Excel

Certifications & Qualifications

State Certification or License

Industry Keywords

Workers' Compensation LawsStatutory RequirementsMedical-Only ClaimsClaims Handling Instructions

About the role

Key responsibilities & impact

Manage workers’ compensation medical-only claims from inception through resolution, with total claim exposure not exceeding $10,000 and within assigned authority limits
Initiate and conduct timely investigations to gather information needed to evaluate claims
Determine compensability of medical-only claims in accordance with applicable state laws and company guidelines
Coordinate and monitor medical treatment and medical billing, providing authorization within assigned authority
Communicate with claimants, employers, medical providers, vendors, clients, and TRISTAR staff regarding claim status, treatment, billing, and other claims issues
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 requiring supervisory review
Refer claims exceeding $10,000 in total exposure or the medical-only scope to a supervisor
Maintain a diary system for timely case review and document claim files accurately
Communicate relevant information to clients, including injury trends and safety concerns
Adhere to company policies, procedures, and client claims-handling instructions
Participate in file reviews and perform other duties as assigned

Requirements

What you’ll need

High School Diploma or GED listed as the education level
Bachelor’s degree in a related field preferred
One (1) to three (3) years of related experience
Equivalent combination of education and experience accepted
Working knowledge of applicable workers’ compensation laws, statutory requirements, and medical terminology relevant to medical-only claims
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 seek supervisory guidance promptly
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