Workers Compensation Claims Examiner III

TRISTAR Insurance Group

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

Posted 10/27/2026full-timeRancho Cordova • California • United StatesMid-LevelSenior💰 $90,000 - $95,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing complex indemnity claims, including conducting investigations, determining compensability, and adhering to statutory regulations. Proficient in communication and collaboration with various stakeholders while mentoring less experienced team members.

Highest-signal resume keywords

Indemnity Claims ManagementStatutory Regulations KnowledgeAnalytical SkillsExcellent Communication SkillsClaims Investigation

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ManagementCompensability DeterminationMedical Treatment ManagementReserve ComputationSubrogation InvestigationFile ReviewDiary System MaintenanceBenefits AdministrationClaims SettlementStatistical Reporting

Soft Skills

MentoringInterpersonal SkillsIndependent ManagementEffective CommunicationTeam Collaboration

Tools & Technologies

Microsoft WordMicrosoft Excel

Certifications & Qualifications

Licenses as Required by Jurisdiction

Industry Keywords

Litigated ClaimsMedical BillingTRISTAR Best PracticesWorkers' CompensationClaims ApportionmentClaims RecoveryState Audit Compliance

About the role

Key responsibilities & impact

Manage all aspects of complex and litigated indemnity claims from inception to conclusion within established authority and guidelines
Manage a caseload of indemnity claim files, including very complex and litigated claims
Initiate and conduct timely investigations
Determine claim compensability and administer benefits according to state law and TRISTAR best practices
Manage medical treatment and medical billing, authorizing as appropriate
Refer cases to outside defense counsel and participate in litigated matters
Communicate with claimants, attorneys, providers, and vendors regarding claims issues
Compute and set reserves within company guidelines
Settle and/or finalize claims and obtain designated authority
Maintain diary systems and document claim files with status and action plans
Communicate claim information promptly to clients, including injury trends and safety concerns
Conduct scheduled file reviews
Identify and review claims for apportionment assignment
Identify and investigate subrogation potential and pursue recovery
Identify claim criteria for excess reporting and reimbursement
Assist with state audit and reporting responses
Mentor less experienced Examiners
Perform other assigned duties, including claims management for other jurisdictions' workers' compensation claims
Adhere to TRISTAR company policies and procedures

Requirements

What you’ll need

Minimum 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)
Licenses as required by Jurisdiction
Ability to perform light work and associated physical activities
Near, mid-range, and far vision requirements
Frequent talking, hearing, and repetitive wrist, hand, and finger motions

Benefits

Comp & perks

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