Senior Claims Examiner - Remote Workers' Comp Expert

TRISTAR Company; Corpus Christi (TX); Remote; USD 60,000 - 75,000; Full time

Benefits offered by this job

Medical, Dental, Vision Insurance

Life and Disability Insurance

401(k) Plan

Paid Holidays

Paid Time Off

Referral bonus

Job summary

TRISTAR Company is seeking a Claims Examiner III for a fully remote role, with location flexibility in Corpus Christi, Texas. You will manage a large, complex workers’ compensation caseload and coordinate with claimants, providers, and legal teams.

Under minimal supervision, you’ll determine compensability, administer benefits, review medical treatment, and set reserves while adhering to company guidelines and state law. Texas license is required.

Qualifications

• Bachelor’s degree in a related field is preferred; three or more years of related experience or equivalent.
• Texas Workers' Compensation License is required or preferred.
• Strong knowledge of statutory regulations and medical terminology.
• Analytical and communication skills; ability to explain complex details clearly.

Responsibilities

• Manage a caseload of 150 workers’ compensation files, including complex claims.
• Initiate and conduct investigations in a timely manner.
• Determine claimants' entitlements and administer benefits per state law and company guidelines.
• Manage medical treatment and medical billing; authorize as appropriate.
• Refer cases to outside defense counsel and direct as needed.
• Communicate with claimants, providers, and vendors about claims issues.
• Compute and set reserves within company guidelines.
• Settle and finalize claims with designated authority.
• Maintain diary system and update file status as work progresses.

Skills

Analytical skills

Excellent written and verbal沟通 skills

Education

Bachelor’s degree in related field

Texas Workers' Compensation License

Tools

Word

Excel

Job description

TRISTAR Company is seeking a Claims Examiner III for a fully remote role, with location flexibility in Corpus Christi, Texas. You will manage a large, complex workers’ compensation caseload and coordinate with claimants, providers, and legal teams.

Under minimal supervision, you’ll determine compensability, administer benefits, review medical treatment, and set reserves while adhering to company guidelines and state law. Texas license is required.