Claims Specialist

• Independently manage approximately 125–150 highly complex workers’ compensation indemnity claims in the Texas jurisdiction from inception through resolution
• Evaluate difficult compensability, medical, disability, and litigation issues
• Develop claims resolution strategies
• Establish and adjust reserves and authorize payments and settlements within assigned authority limits
• Direct defense counsel and evaluate litigation strategy, significant legal developments, and settlement recommendations
• Prepare detailed captioned reports covering claim status, exposure, reserves, litigation strategy, and recommended resolution
• Escalate matters exceeding assigned authority or requiring management involvement
• Provide technical guidance to less experienced Claims Examiners without formal supervisory responsibility

Workers Compensation Claims Examiner III

• Manage workers’ compensation medical-only claims from inception through resolution, with total exposure not exceeding $10,000 and within assigned authority limits
• Initiate and conduct timely claim investigations
• Determine compensability in accordance with applicable state laws and company guidelines
• Coordinate and monitor medical treatment and medical billing
• Communicate with claimants, employers, medical providers, vendors, clients, and TRISTAR staff
• 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
• Refer claims exceeding $10,000 or the medical-only scope to a supervisor
• Maintain a diary system and accurate claim documentation
• Communicate injury trends and safety concerns to clients
• Participate in file reviews and perform other assigned duties

Workers' Compensation Claims Examiner I - Medical Only

• Manage approximately 150–180 workers’ compensation claims of moderate to complex difficulty
• Manage indemnity claims from inception through resolution within assigned authority limits and company/client guidelines
• Calculate and establish reserves
• Authorize payments and settlements within assigned authority limits
• Identify and escalate claims involving significant exposure, unusual compensability issues, sensitive client concerns, or decisions exceeding authority
• Refer claims to defense counsel as appropriate
• Monitor litigation activities
• Consult with the supervisor on significant legal developments and settlement strategy
• Exercise independent judgment in routine and complex claims handling
• Seek supervisory guidance on unusual, high-exposure, or sensitive matters

Workers Compensation Claims Examiner II

• Manage all aspects of Professional Liability claims from inception through resolution within established authority and company guidelines
• Review policy information, endorsements, and vehicle schedules to determine coverage for loss, damage, or injury
• Examine and investigate claims, including matters in litigation, through final resolution
• Interact frequently with claimants and their legal representatives
• Communicate loss exposure, reserves, and settlement strategy recommendations to clients
• Review, process, and conclude assigned claims
• Interpret policies and make coverage determinations
• Oversee and direct outside investigative service providers
• Work with clients, client counsel, and investigative services to advance claims
• Maintain an ongoing claim diary
• Assess exposure and evaluate reserves and settlement recommendations
• Prepare detailed Loss Reports analyzing liability and damages
• Determine and initiate subrogation or risk-transfer recovery efforts when applicable
• Document correspondence, reports, discussions, and decisions in claim files
• Provide outstanding client service
• Assist supervisors and the Claims Department with requested tasks and special projects
• Perform other duties as assigned
• Work remotely from home under the oversight of the Area Manager and reporting to the Claim Supervisor and/or Area Manager

Professional Liability Claims Examiner III

• 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

Workers' Compensation Claims Examiner I – Medical Only

• Manage all aspects of Professional Liability claims from inception through resolution within established authority and company guidelines
• Review policy information, endorsements, and vehicle schedules to determine coverage for loss, damage, or injury
• Examine and investigate claims, including matters in litigation, through final resolution
• Interact frequently with claimants and their legal representatives
• Communicate recommendations regarding loss exposure, reserves, and settlement strategy to clients
• Review, process, and conclude assigned professional liability claims
• Interpret policies and make coverage determinations
• Oversee and direct outside investigative service providers
• Work with clients, client counsel, and investigative services to advance claims to conclusion
• Maintain an ongoing claim diary
• Assess exposure and evaluate reserves and settlement recommendations
• Prepare detailed Loss Reports analyzing liability and damages
• Determine and initiate subrogation or risk-transfer recovery efforts when applicable
• Document correspondence, reports, discussions, and decisions in claim files
• Provide outstanding client service
• Assist supervisors and the Claim Department with requested tasks or special projects
• Work remotely from home under the oversight of the Area Manager and reporting to the Claim Supervisor and/or Area Manager

Professional Liability Claims Examiner, III

• Manage workers’ compensation indemnity claims of moderate to complex difficulty from inception through resolution
• Exercise independent judgment in routine and complex claims handling
• Seek supervisory guidance on unusual, high-exposure, or sensitive matters
• Manage a caseload of approximately 150–180 workers’ compensation claims
• Calculate and establish reserves
• Authorize payments and settlements within assigned authority limits
• Identify and escalate claims involving significant exposure, unusual compensability issues, sensitive client concerns, or decisions exceeding assigned authority
• Refer claims to defense counsel as appropriate
• Monitor litigation activities
• Consult with the supervisor on significant legal developments and settlement strategy

• Evaluate and adjudicate complex claims, including those in litigation, ensuring compliance with all legal and regulatory requirements.
• Oversee the investigation, evaluation, and resolution of bodily injury claims involving company vehicles or drivers.
• Prepare detailed file summaries for internal reporting, large loss assessments, and reinsurance purposes, ensuring all pertinent information is accurately documented.
• Ensure all bodily injury claims are handled in accordance with industry best practices and company policies.
• Adjust physical damage claims including unreported damage claims.
• Negotiate directly with insurance company adjusters, claimants, and third-party claimant representatives upon receipt of critical information.
• Discuss accidents, damage, preventability and processes with commercial vehicle operators.
• Maintain files for litigation, subrogation, physical damage, liability and workers compensation claims.
• Report claims and accidents as necessary.
• Be available on-call for nights and weekends for serious accidents and other duties as necessary.
• Select, direct and manage vendor relationships including towing companies, body shops, garage and parking/storage yards to get accurate costs as needed in settlement of claims.
• Update and post payments for repairs.
• Order police reports, set up new claim files, and confirm loss to insurer and broker.
• Communicate with the Claims team as well as the Safety/Compliance team and others as necessary on relevant items.

Transportation Claims Adjuster

• Manage complex claims inventories requiring advanced technical expertise and strategic claim handling
• Communicate with policyholders, agents, attorneys, and witnesses to gather information and provide customer service
• Investigate claims to determine exposure, work with experts, and make strategic recommendations
• Use mediation, negotiation, denial, litigation, or offers to drive claim resolutions
• Follow state or governing-entity rules, regulations, and internal claims-handling policies
• Direct defense counsel throughout litigation and monitor legal fees and costs
• Collaborate with cross-functional team members on projects and process discussions
• Recommend process improvements and industry best practices
• Ensure claims-system data accuracy for regulatory reporting
• Provide knowledge transfer and mentor or train less experienced team members
• Prepare and present claims status reports for internal and external stakeholders
• Administer, manage, and approve benefits payments to injured workers within designated authority
• Create and adjust reserves in accordance with company policies
• Resolve claims fairly and equitably while providing legally required timely benefits
• Support specialty claim programs and strategic initiatives involving complex litigation, medical exposure, catastrophic injuries, fatalities, PTD, and long-duration claims
• Provide technical guidance to leadership on complex claim resolution strategies
• Drive resolution of complex or long-duration claims through settlement, reserving, and medical-management strategies

Claims Specialist – Workers' Compensation

• Investigate, evaluate and adjust Arizona workers’ compensation claims
• Establish reserves and provide reserve recommendations within authority levels
• Review, approve or oversee medical, legal, damage estimate and miscellaneous invoices
• Negotiate disputed bills and invoices
• Authorize and make claim payments using a claim payment program
• Negotiate settlements according to corporate standards, client instructions and state laws
• Select, refer and supervise claim files sent to outside vendors
• Assess and monitor subrogation claims
• Review and maintain claim-system diaries
• Prepare reports detailing claim status, payments and reserves
• Compute disability rates in accordance with state laws
• Coordinate communications with clients, claimants and other parties
• Provide notices of qualifying claims to excess/reinsurance carriers
• Handle complex claims with minimal supervision
• Conduct claim reviews and training sessions for designated clients
• Attend hearings, mediations and informal legal conferences
• Comply with corporate claim-handling standards and client instructions
• Support client satisfaction

Claims Specialist jobs in United States

Workers Compensation Claims Examiner III

Workers' Compensation Claims Examiner I - Medical Only

Workers Compensation Claims Examiner II

Professional Liability Claims Examiner III

Workers' Compensation Claims Examiner I – Medical Only

Professional Liability Claims Examiner, III

Workers Compensation Claims Examiner II

Transportation Claims Adjuster

Claims Specialist – Workers' Compensation

Workers' Compensation Claims Adjuster