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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.
Workers' Compensation Claims Examiner III – Hybrid Texas
Handle complex Texas workers’ compensation indemnity claims from initial review through final resolution. The role covers exposure assessment, litigation oversight, reserves, settlements, and defense strategy.
United States
Texas$80,000 – $85,000 / year
HybridFull-timeMiddleSeniorEnglish RequiredClaims SpecialistDescription
- Manage a portfolio of approximately 125–150 highly complex Texas workers’ compensation indemnity claims from intake through resolution.
- Assess challenging compensability, medical, disability, and litigation issues.
- Create practical strategies for resolving complex claims.
- Set and revise reserves and approve payments and settlements within delegated authority.
- Manage defense counsel while reviewing litigation strategy, major legal developments, and settlement proposals.
- Produce detailed, captioned reports on claim status, exposure, reserves, litigation strategy, and recommended outcomes.
- Refer matters beyond delegated authority or requiring management review.
- Offer technical support to less experienced Claims Examiners without direct supervisory responsibility.
Requirements
- High school diploma or GED.
- At least three years of related experience.
- Advanced knowledge of Texas workers’ compensation law, regulations, and claims-handling requirements.
- Ability to independently handle highly complex, litigated, and high-exposure claims with limited supervision.
- Ability to assess exposure, formulate resolution strategies, and apply sound judgment within delegated authority.
- State-required certification or license.
- Ability to meet the role’s mental and physical demands, including sedentary work, fingering, grasping, speaking, hearing, and repetitive wrist, hand, and finger movements.
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