LogoFresh Jobs Ahead
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.
LinkedIn
Company Jobs

Workers' Compensation Claims Examiner I – Medical Only (Hybrid)

TRISTAR Insurance Group is seeking a hybrid Workers’ Compensation Claims Examiner I to handle medical-only claims. The role covers investigations, treatment and billing coordination, reserves, communications, and accurate claims documentation.

USUnited StatesTXTexas
$24 – $26 / hour
HybridFull-timeJuniorNo degree requiredEnglish RequiredClaims Specialist

Description

  • Handle medical-only workers’ compensation claims from intake through resolution, keeping total exposure at or below $10,000 and operating within delegated authority.
  • Conduct prompt investigations and collect the information required for claim evaluation.
  • Assess compensability in line with applicable state laws and TRISTAR guidelines.
  • Coordinate medical care and billing, issuing treatment or payment authorization within assigned authority.
  • Discuss claim status, treatment, billing, and related issues with claimants, employers, providers, vendors, clients, and TRISTAR personnel.
  • Set, calculate, and revise claim reserves according to authority limits and company standards.
  • Watch for lost time, possible indemnity benefits, rising medical costs, litigation, or other developments that warrant supervisory involvement.
  • Escalate claims that exceed $10,000 in exposure or fall outside the medical-only scope.
  • Use the diary system for scheduled reviews and maintain complete, accurate claim files.
  • Share relevant client information, including injury patterns and safety issues.
  • Follow company procedures, policies, and client-specific claims-handling directions.
  • Support file reviews and complete additional assigned responsibilities.

Requirements

  • High school diploma or GED is the stated education requirement.
  • A bachelor’s degree in a related discipline is preferred.
  • One to three years of relevant experience is required.
  • An equivalent combination of education and experience may be considered.
  • Working knowledge of workers’ compensation laws, statutory obligations, and medical terminology used in medical-only claims.
  • Capability to investigate and administer medical-only claims within delegated authority and established procedures.
  • Analytical ability to assess claim details, medical records, and billing information.
  • Judgment to identify changes in exposure or complexity and promptly involve a supervisor.
  • Strong organization skills, including diary management, task prioritization, and deadline control.
  • Clear and effective written and spoken communication.
  • Professional, comfortable interaction with people at all levels of the business.
  • Microsoft Word and Excel proficiency is preferred.
  • Maintain any certification or license required by state regulations.

Related Jobs

Kreato Global | BPO and Language Solutions

Remote English-Spanish OPI/VRI Interpreter

Kreato Global | BPO and Language Solutions
201 – 500 Employees
HealthcareHospitalityLogistics
ARArgentinaBOBoliviaBRBrazilCLChileCOColombiaCRCosta RicaCUCubaDODominican RepublicECEcuadorGTGuatemalaHNHondurasHTHaitiMXMexicoNINicaraguaPAPanamaPEPeruPRPuerto RicoPYParaguaySVEl SalvadorUYUruguayVEVenezuelaRemoteFull-timeJuniorNo degree requiredEnglish RequiredSpanish RequiredTranslator

Interpret remotely between English- and Spanish-speaking people in medical, financial, social service, and customer care settings. Provide language support for Kreato Global across Latin America.

Open