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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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Workers' Compensation Claims Examiner II

Handle 150–180 moderate-to-complex workers’ compensation indemnity claims from intake through resolution. Set reserves, approve payments and settlements, coordinate defense counsel, and monitor litigation within assigned authority.

USUnited StatesTXTexas
$70,000 – $75,000 / year
HybridFull-timeMiddleSeniorEnglish RequiredClaims Specialist

Description

  • Oversee approximately 150–180 moderate-to-complex workers’ compensation claims
  • Manage indemnity claims from initial assignment through resolution in line with authority limits and company or client guidelines
  • Calculate and set claim reserves
  • Approve payments and settlements within delegated authority
  • Recognize and escalate high-exposure claims, unusual compensability issues, sensitive client matters, and decisions beyond assigned authority
  • Refer claims to defense counsel when appropriate
  • Track litigation activity
  • Discuss significant legal developments and settlement strategy with the supervisor
  • Apply independent judgment to routine and complex claims decisions
  • Obtain supervisory direction for unusual, high-exposure, or sensitive claims

Requirements

  • High school diploma or GED
  • Bachelor’s degree in a related discipline preferred
  • Three to five years of relevant experience, or an equivalent combination of education and experience
  • Working knowledge of statutory regulations and medical terminology
  • Strong analytical ability
  • Excellent written and verbal communication skills, including the ability to explain technical information to claimants, clients, and staff
  • Ability to work effectively with people at all levels of a business organization
  • Ability to independently manage highly complex claims effectively
  • Proficiency with Microsoft Word and Excel preferred
  • State-required certification or licensure

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