Workers Compensation Claims Examiner II

Tristar Insurance • Irving, TX

3d • $50,000 - $55,000

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.

The role manages a caseload of approximately 150–180 claims. It calculates and establishes reserves and authorizes payments and settlements within assigned authority limits, which are lower than those assigned to Claims Examiner III. The examiner identifies and escalates claims involving significant exposure, unusual compensability issues, sensitive client concerns, or decisions beyond their authority. The role also refers claims to defense counsel as appropriate and monitors litigation activities, consulting with a supervisor on significant legal developments and settlement strategy.

Requirements

• 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 convey 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 Word and Excel.

Responsibilities

• Manage approximately 150–180 workers’ compensation claims of moderate to complex difficulty from inception through resolution.
• 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 exceeding assigned authority.
• Refer claims to defense counsel as appropriate and monitor litigation activities.
• Consult with a supervisor on significant legal developments and settlement strategy.
• Seek supervisory guidance on unusual, high-exposure, or sensitive matters.

What This Job Offers

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