Workers Compensation Claims Examiner II

Tristar Insurance • Irving, TX

21h • $70,000 - $75,000 • Onsite

About The Position

Under general supervision, manages workers’ compensation indemnity claims of moderate to complex difficulty from inception through resolution, within assigned authority limits and established company and client guidelines. Exercises independent judgment in routine and complex claims handling and seeks supervisory guidance on unusual, high-exposure, or sensitive matters. Manages an approximate caseload of 150–180 claims. The position is based in Dallas–Irving, Texas, and is full-time on the day shift, with no travel indicated.

Requirements

• High school diploma or GED is listed as the education level; the qualifications section states a bachelor’s degree in a related field is preferred, or an equivalent combination of education and experience.
• Three to five years of related experience, or an equivalent combination of education and experience.
• Technical knowledge of statutory regulations and medical terminology.
• Analytical skills.
• Excellent written and verbal communication skills, including the ability to explain technical details to claimants, clients, and staff.
• Ability to interact with people at all levels in a business environment.
• Ability to independently and effectively manage very complex claims.
• Certification and/or license as required by state regulation.

Nice To Haves

• Bachelor’s degree in a related field.
• Proficiency in Microsoft Word and Excel.

Responsibilities

• Manage a caseload of approximately 150–180 workers’ compensation claims of moderate to complex difficulty.
• Calculate and establish reserves and authorize payments and settlements within assigned authority limits.
• Identify and escalate claims involving significant exposure, unusual compensability issues, sensitive client concerns, or decisions that exceed assigned authority.
• Refer claims to defense counsel as appropriate and monitor litigation activities.
• Consult with the supervisor about significant legal developments and settlement strategy.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED