Workers' Compensation Claims Examiner III

Job not on LinkedIn

🔥 19 hours ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $60k - $75k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 Ghost score 2%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 indemnity claims handling from inception to conclusion within established authority and guidelines • Manage a caseload of 150 workers’ compensation files, including very complex claims • Initiate and conduct timely investigations • Determine claim compensability and administer benefits based on 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 diary system for case review and document file status and work performed • Communicate relevant information promptly to clients, including injury trends and safety-related concerns • Involve TRISTAR loss control staff when appropriate • Adhere to Company policies and procedures • Conduct file reviews independently • Perform other duties as assigned

🎯 Requirements

• Bachelor’s degree in a related field (preferred) • Three (3) or more years of related experience • Equivalent combination of education and experience accepted • 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) • Texas Workers' Compensation License • Ability to use a computer, 10-key, fax machine, copier, printer, and other office equipment • Ability to meet the stated mental and physical requirements, including light work and frequent talking, hearing, and repetitive wrist, hand, and finger movements

🏖️ Benefits

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