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TRISTAR Insurance Group
TRISTAR Insurance Group
501 – 1,000 Employees
ConsultingHealthcareLogistics
TRISTAR Insurance Group is a national third-party administrator serving employers, insurers, and public entities with insurance administration and risk management services. The company supports property and casualty programs, workers’ compensation, general and auto liability, managed care, absence and disability management, employee group benefits administration, and workplace safety. Its managed care capabilities include bill review, case management, utilization review, nurse triage, and pharmacy benefit management. TRISTAR combines technology-enabled operations with tailored service to help clients manage risk across complex insurance and employee benefit needs.
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Professional Liability Claims Examiner III - Texas Remote

Handle complex professional liability claims remotely in Texas, from coverage review and investigation through settlement and closure. The role includes reserve evaluation, litigation-related claims, client communication, and recovery assessment.

USUnited StatesTXTexas
$80,000 – $95,000 / year
RemoteFull-timeMiddleSeniorEnglish RequiredClaims Specialist

Description

  • Manage professional liability claims from initial assignment through resolution in line with authority limits and company procedures.
  • Review policies, endorsements, and vehicle schedules to establish coverage for loss, damage, or injury.
  • Investigate claims, including litigated matters, through final disposition.
  • Communicate regularly with claimants and their attorneys.
  • Explain loss exposure, reserve positions, and settlement strategy recommendations to clients.
  • Process, review, and close assigned claims.
  • Interpret policy language and make coverage decisions.
  • Coordinate and oversee external investigative vendors.
  • Collaborate with clients, client counsel, and investigative providers to move claims forward.
  • Keep claim diaries current throughout the claim lifecycle.
  • Evaluate exposure and develop reserve and settlement recommendations.
  • Produce detailed loss reports addressing liability and damages.
  • Identify and begin subrogation or risk-transfer recovery actions when appropriate.
  • Record correspondence, reports, discussions, and decisions in claim files.
  • Deliver responsive service to clients.
  • Support supervisors and the Claims Department with assigned tasks and special projects.
  • Complete additional duties as directed.
  • Work from home under the Area Manager's supervision while reporting to the Claim Supervisor and/or Area Manager.

Requirements

  • A bachelor's degree in a related discipline is preferred.
  • At least five years of relevant professional experience.
  • A comparable combination of education and experience may be considered.
  • Technical understanding of coverage, statutory requirements, and medical terminology.
  • Strong analytical capability.
  • Excellent written and verbal communication skills, including the ability to explain technical information to claimants, clients, and colleagues.
  • Ability to work effectively with people across all levels of a business.
  • Capacity to manage highly complex claims independently and effectively.
  • Working proficiency with Microsoft Word and Excel is preferred.
  • Current Independent Adjuster license in New York State.
  • Ability to perform sedentary or light work and the specified mental, visual, physical, and communication functions.

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