Professional Liability Claims Examiner III

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🤠 Texas – Remote

🤠 Texas – Remote

💵 $80k - $95k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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TRISTAR Insurance Group

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1987

💼 Consulting

🏥 Healthcare

📦 Logistics

Consulting • Healthcare • Logistics

TRISTAR Insurance Group is a national third-party administrator (TPA) that provides insurance administration and risk management services to employers, insurers and public entities. Its solutions include property & casualty, workers' compensation, general and auto liability, managed care (bill review, case management, utilization review, nurse triage, pharmacy benefit management), absence and disability management, employee group benefits administration, and risk control and workplace safety services. TRISTAR emphasizes collaborative, technology-enabled and tailored services to transform risk into opportunity for its clients.

📋 Description

• 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

🎯 Requirements

• Bachelor’s degree in related field (preferred) • Five (5) or more years related experience • Equivalent combination of education and experience accepted • Technical knowledge of coverage, 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 people at all levels in the business environment • Ability to independently and effectively manage very complex claims • Proficient in Word and Excel (preferred) • Active Independent Adjuster New York State License • Ability to perform sedentary/light work and the listed mental, visual, physical, and communication activities