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 10/24/2026full-timeRemote • Texas • United StatesMid-LevelSenior💰 $60,000 - $75,000 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 staff.

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 ExcelOffice Equipment Usage

Certifications & Qualifications

Texas Workers' Compensation License

Industry Keywords

Claims AdministrationMedical BillingCase ManagementLoss ControlSafety Concerns

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 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
Refer cases to outside defense counsel and direct/manage them as appropriate
Communicate with claimants, providers, and vendors regarding claims issues
Compute and set reserves within Company guidelines
Settle and/or finalize claims and obtain designated authority
Maintain diary system for case review and document file status and work performed
Communicate relevant information promptly to clients, including injury trends and safety-related concerns
Involve TRISTAR loss control staff when appropriate
Adhere to Company policies and procedures
Conduct file reviews independently
Perform other duties as assigned

Requirements

What you’ll need

Bachelor’s degree in a related field (preferred)
Three (3) or more years of related experience
Equivalent combination of education and experience accepted
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 use a computer, 10-key, fax machine, copier, printer, and other office equipment
Ability to meet the stated mental and physical requirements, including light work and frequent talking, hearing, and repetitive wrist, hand, and finger movements

Benefits

Comp & perks

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