Senior Workers' Comp Claims Examiner — Complex Caseload

Tristar Insurance; Signal Hill (CA); On-site; USD 94,000 - 104,000; Part time

Benefits offered by this job

Medical, Dental & Vision Insurance

Life & Disability Insurance

401(k) Plan

Paid Time Off

Paid Holidays

Job summary

TRISTAR INSURANCE is seeking an experienced indemnity claims examiner in Signal Hill, CA. The role manages a large caseload of workers’ compensation files from inception to resolution, with substantial client interaction and office presence.

Under minimal supervision, you will investigate, determine compensability, manage medical treatment and billing, and coordinate with counsel as needed. A strong background in claims and regulations is essential.

Qualifications

• Bachelor’s degree in related field; 3+ years experience or equivalent.
• Technical knowledge of statutes and medical terminology.
• Excellent written and verbal communication; able to convey complex details.

Responsibilities

• Manage a caseload of 150–180 workers’ compensation files, including complex claims.
• Initiate and conduct investigations in a timely manner.
• Determine compensability and administer benefits per state law and guidelines.
• Manage medical treatment and billing; authorize as appropriate.
• Refer cases to outside defense counsel and direct/manage as needed.
• Communicate with claimants, providers, and vendors regarding issues.
• Compute and set reserves within guidelines; settle and finalize claims as designated.
• Maintain diary system for review and document status; report trends to client.

Skills

Analytical abilities

Communication skills

Claims management

Interpersonal skills

Education

Bachelor’s degree or equivalent

Tools

Microsoft Word

Microsoft Excel

Job description

TRISTAR INSURANCE is seeking an experienced indemnity claims examiner in Signal Hill, CA. The role manages a large caseload of workers’ compensation files from inception to resolution, with substantial client interaction and office presence.

Under minimal supervision, you will investigate, determine compensability, manage medical treatment and billing, and coordinate with counsel as needed. A strong background in claims and regulations is essential.