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 11/11/2026full-timeLake Oswego • Oregon • United StatesJuniorMid-Level💰 $65,000 - $90,000 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 state 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 Claims HandlingStatutory Regulations KnowledgeExcellent Communication SkillsAnalytical Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims Compensability DeterminationMedical Treatment ManagementReserve ComputationFile ReviewInvestigation Initiation

Soft Skills

Ability to Interact with All LevelsIndependent Management of Complex Claims

Tools & Technologies

Microsoft WordMicrosoft Excel

Certifications & Qualifications

OR CertificationWA Certification

Industry Keywords

Self-Insured ClientsMedical TerminologyClaims DocumentationDiary System MaintenanceLoss Control Staff Involvement

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 up to 135 workers’ compensation files, including very complex claims
Initiate and conduct timely investigations
Determine claim compensability and administer benefits according to 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 the diary system and document files
Communicate relevant information promptly to clients, including injury trends and safety-related concerns
Involve TRISTAR loss control staff when appropriate
Conduct file reviews independently
Adhere to company policies and procedures
Perform other duties as assigned

Requirements

What you’ll need

High School Diploma or GED required
Bachelor’s degree in related field preferred
2–5 years’ experience handling OR and/or WA claims, working with self-insured clients
Technical knowledge of statutory regulations and medical terminology
Analytical skills
Excellent written and verbal communication skills
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
Proficiency in Word and Excel preferred
OR certification or ability to become certified in OR
WA certification or ability to become certified in WA
Ability to perform the stated mental and physical requirements
Appropriate office attire