Senior Workers' Compensation Claims Examiner

Tristar-d43fac80; Waukesha (WI); On-site; USD 60,000 - 80,000; Full time

Job summary

Tristar-d43fac80 is seeking a Claims Examiner II to oversee a workers’ compensation caseload and administer indemnity and medical benefits in line with company policies and state rules. The role involves coordinating treatment, reviewing bills, and maintaining precise documentation for all claim activities.

The candidate should have 3+ years of related experience, strong analytical and communication skills, and proficiency with Word and Excel. Overtime may apply under applicable wage laws.

Qualifications

• High school diploma or GED required; bachelor's degree preferred.
• 3+ years of related experience or equivalent combination of education and experience.
• Knowledge of statutory regulations and medical terminology.

Responsibilities

• Manage a workers’ compensation caseload of roughly 110–130 files depending on complexity.
• Perform initial claim setup and investigations per company procedures.
• Gather claim information from claimants, employers, medical providers, and others.
• Apply company guidelines and state regulations to indemnity and medical benefits.
• Coordinate medical treatment and review medical billing within authority levels.
• Maintain accurate claim documentation and use the diary system to monitor activity.
• Prepare reserve recommendations and escalate complex issues to supervision.
• Participate in reviews, meetings, and training as requested.

Skills

Analytical skills

Excellent written and verbal

Word

Excel

Education

High school diploma or GED

Bachelor’s degree preferred

Tools

Microsoft Word

Microsoft Excel

Job description

Tristar-d43fac80 is seeking a Claims Examiner II to oversee a workers’ compensation caseload and administer indemnity and medical benefits in line with company policies and state rules. The role involves coordinating treatment, reviewing bills, and maintaining precise documentation for all claim activities.

The candidate should have 3+ years of related experience, strong analytical and communication skills, and proficiency with Word and Excel. Overtime may apply under applicable wage laws.