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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.
Professional Liability Claims Examiner III - Texas Remote
Manage complex professional liability claims for TRISTAR Insurance Group in a fully remote Texas role. Responsibilities include coverage analysis, liability investigations, reserve evaluation, settlement recommendations, and claim resolution.
United States
Texas$80,000 – $95,000 / year
RemoteFull-timeMiddleSeniorEnglish RequiredClaims SpecialistDescription
- Administer professional liability claims from initial notice through closure while following assigned authority and company procedures
- Analyze policies, endorsements, and vehicle schedules to establish coverage for loss, damage, or injury
- Investigate claims, including litigated matters, and guide them through final resolution
- Communicate regularly with claimants and their attorneys or other legal representatives
- Advise clients on loss exposure, reserves, and settlement approaches
- Process, evaluate, and finalize assigned professional liability claims
- Interpret policy language and issue coverage decisions
- Coordinate and supervise external investigative vendors
- Collaborate with clients, client counsel, and investigative providers to move claims toward resolution
- Keep claim diaries current throughout the claim lifecycle
- Evaluate exposure and review reserve and settlement recommendations
- Produce detailed Loss Reports covering liability and damages
- Identify and begin subrogation or risk-transfer recovery actions when appropriate
- Maintain complete records of correspondence, reports, conversations, and claim decisions
- Deliver responsive client service
- Support supervisors and the Claims Department with assigned work and special projects
- Work from home under the Area Manager’s direction and report to the Claim Supervisor and/or Area Manager
Requirements
- Bachelor’s degree in a related discipline preferred, plus at least five years of relevant experience, or an equivalent combination of education and experience
- Working knowledge of coverage, statutory requirements, and medical terminology
- Strong analytical ability
- Clear written and verbal communication skills, including the ability to explain technical information to claimants, clients, and colleagues
- Confidence working with people across all levels of a business
- Capacity to independently manage highly complex claims effectively
- Proficiency with Microsoft Word and Excel preferred
- Current New York State Independent Adjuster license
- High school diploma or GED
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