Workers Compensation Claims Examiner III

TRISTAR Insurance Group

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

Posted 11/10/2026full-timeHouston • Texas • United StatesMid-LevelSenior💰 $73,000 - $87,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing indemnity claims, including complex workers' compensation cases, while adhering to statutory regulations and company guidelines. Proficient in communication and analytical skills to effectively interact with claimants, clients, and medical providers.

Highest-signal resume keywords

Indemnity Claims ManagementWorkers' Compensation ExpertiseTexas Workers Compensation LicenseAnalytical SkillsExcellent Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims HandlingInvestigation InitiationCompensability DeterminationMedical Treatment ManagementReserve ComputationFile ReviewStatutory Regulations KnowledgeMedical Terminology Knowledge

Soft Skills

Interpersonal SkillsIndependent ManagementEffective Communication

Tools & Technologies

Microsoft WordMicrosoft Excel

Certifications & Qualifications

Texas Workers Compensation License

Industry Keywords

Workers' CompensationClaims ExaminersMedical BillingCase ReviewCompany Policies

About the role

Key responsibilities & impact

Manage all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines
Manage a caseload of 110 to 150 workers’ compensation files, including very complex claims
Initiate and conduct timely investigations
Determine claim compensability and administer benefits based on state law and company guidelines
Manage medical treatment and medical billing, authorizing as appropriate
Communicate with claimants, providers, vendors, clients, management, Claims Examiners, and other staff regarding claims issues
Compute and set reserves within company guidelines
Maintain the diary system for case review and document files to reflect status and work performed
Communicate relevant information promptly to clients, including injury trends and safety concerns
Adhere to company policies and procedures
Conduct file reviews independently
Perform other duties as assigned

Requirements

What you’ll need

High School Diploma or GED required
Bachelor’s degree in related field preferred
Five (5) or more years 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
Ability to independently and effectively manage very complex claims
Proficient in Word and Excel preferred
Texas Workers Compensation License
Ability to perform light work and required physical activities, including standing, walking, lifting, fingering, grasping, talking, hearing, and repetitive wrist, hand, and finger motions