Workers Compensation Claims Examiner III _ New York

Workers Compensation Claims Examiner III _ New York This is a remote position or it can be a hybrid position if the adjuster lives in the Philadelphia area. Position summary: Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. This is a full-time position that requires considerable interaction with clients, claimants on the phone, and with management, other Claims Examiners, and other TRISTAR staff in the office; therefore consistently being at work in the office, in a timely manner, is inherently required of this position. Duties and responsibilities: Adjuster will work remotely from home Effectively manages a caseload of 100 to 125 workers' compensation files, including very complex claims. Jurisdiction is NY. Initiates and conducts investigations in a timely manner. Determines compensability of claims and administers benefits, based upon state law and in accordance with established Company guidelines. Manages medical treatment and medical billing, authorizing as appropriate. Refers cases to outside defense counsel. Directs and manages as appropriate. Communicates with claimants, providers, and vendors regarding claims issues. Computes and sets reserves within Company guidelines. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II. Settles and/or finalizes all claims and obtains authority as designated. Maintains diary system for case review and documents file to reflect the status and work being performed on the file. Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety-related concerns. Involves TRISTAR loss control staff when appropriate. Adheres to all Company policies and procedures. Conduct file reviews independently. Other duties as assigned. Equipment operated/used: Computer, fax machine, copier, printer, and other office equipment. Special equipment or clothing: Appropriate business casual office attire Qualifications required: Education/Experience: Bachelor's degree in related field (preferred); three (3) or more years related experience; or equivalent combination of education and experience. Knowledge, skills and abilities: Technical knowledge of statutory regulations and medical terminology. Analytical skills. Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff. Ability to interact with persons at all levels in the business environment. Ability to independently and effectively manage very complex claims. Proficient in Word and Excel (preferred). Other qualifications: Must have a valid New York state adjuster license Here are some of the benefits you can enjoy in this role: Medical, Dental, Vision, Life Insurance & Disability 401 k plan Paid time off Paid holidays

Created: 2026-03-04