Workers Compensation Claims Examiner III

Tristar Insurance • Irving, TX

1d • $80,000 - $85,000 • Onsite

About The Position

Under minimal supervision, independently manages highly complex workers’ compensation indemnity claims, including litigated and high-exposure claims in the Texas jurisdiction, from inception through resolution. Applies advanced technical knowledge and judgment to develop claims strategies, resolve difficult issues, and make decisions within higher assigned authority limits and established company and client guidelines.

Requirements

• High School Diploma or GED required
• three (3) or more years related experience
• Advanced knowledge of Texas workers’ compensation laws, regulations, and claims handling requirements.
• Ability to independently manage highly complex, litigated, and high-exposure claims with minimal supervisory guidance.
• Ability to evaluate claims exposure, develop resolution strategies, and exercise sound judgment within assigned authority.
• Certification and/or license as required by State regulation.

Nice To Haves

• Bachelor’s degree in related field (preferred)

Responsibilities

• Manages a caseload of approximately 125–150 workers’ compensation claims, with an emphasis on highly complex, litigated, and high-exposure indemnity claims.
• Evaluates difficult compensability, medical, disability, and litigation issues and develops appropriate claims resolution strategies.
• Establishes and adjusts reserves and authorizes payments and settlements within assigned authority limits, which are higher than those assigned to Claims Examiner II.
• Directs defense counsel and evaluates litigation strategy, significant legal developments, and settlement recommendations.
• Prepares detailed captioned reports addressing claim status, exposure, reserves, litigation strategy, and recommended resolution.
• Escalates matters exceeding assigned authority or requiring management involvement.
• Provides technical guidance to less experienced Claims Examiners as assigned, without formal supervisory responsibility.

What This Job Offers

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