Worker Compensation Claims Examiner III

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🤠 Texas – Remote

🤠 Texas – Remote

💵 $60k - $75k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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TRISTAR Insurance Group

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1987

🤝 B2B

⚕️ Healthcare Insurance

B2B • Healthcare Insurance

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

• Manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. • Effectively manages a caseload of 150 workers’ compensation files, including very complex claims. • Determines compensability of claims and administers benefits. • Manages medical treatment and medical billing, authorizing as appropriate. • Settles and/or finalizes all claims and obtains authority as designated. • Communicates appropriate information promptly to the client to resolve claims efficiently.

🎯 Requirements

• Bachelor’s degree in related field (preferred) • Three (3) or more years related experience; or equivalent combination of education and experience. • Texas Workers Compensation License • Technical knowledge of statutory regulations and medical terminology. • Analytical skills. • Proficient in Word and Excel (preferred).

🏖️ Benefits

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