Job Description
Job Description
This position is posted by Jobgether on behalf of TRISTAR Insurance Group. We are currently looking for a Claims Examiner III in Rancho Cordova, CA.
This is a hybrid opportunity for a seasoned claims professional to manage complex and litigated indemnity claims from start to resolution. You'll play a vital role in ensuring timely and accurate benefits administration, effective case resolution, and strong client relationships. The environment combines high responsibility with strong collaboration across legal, medical, and vocational stakeholders. Ideal for candidates with SIP certification and a proactive mindset, this role offers a chance to make a direct impact while advancing within a supportive and experienced team.
Accountabilities
- Manage a caseload of complex and litigated indemnity claims in compliance with regulatory and internal standards.
- Investigate claims promptly and determine compensability based on applicable laws and best practices.
- Oversee medical treatment plans and billing, authorizing procedures as appropriate.
- Interface with attorneys, claimants, providers, and internal departments for optimal case outcomes.
- Set and adjust reserves within authority and guidelines; pursue claim settlements and finalize cases.
- Maintain detailed documentation and proactive case planning in diary systems.
- Identify and pursue subrogation and excess reporting opportunities.
- Conduct exit interviews and participate in client file reviews and audits.
- Mentor less experienced examiners and contribute to overall team development.
Support state reporting, audit responses, and multi-jurisdictional claims as needed.
Requirements
- Minimum of 5 years of relevant experience in workers’ compensation claims management.
- SIP certification required.
- Solid knowledge of medical and legal terminology, and regulatory requirements.
- Strong analytical skills with attention to detail in claims evaluation and documentation.
- Excellent verbal and written communication skills for interaction with diverse stakeholders.
- Ability to work both independently and collaboratively in a fast-paced, hybrid setting.
- Proficiency in Microsoft Word and Excel preferred.
- Jurisdictional licenses as required.
Benefits
- Competitive salary based on experience.
- Hybrid work model based in Rancho Cordova, CA.
- Medical, dental, and vision insurance coverage.
- Life and disability insurance.
- 401(k) retirement plan.
- Paid holidays and paid time off (PTO).
- Employee referral bonus program.
- Supportive work environment with mentorship opportunities.
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