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Claims Examiner III Team Leader

Role overview

Qualifications

  • Experience managing Auto Liability and PIP/No-Fault claims from inception through resolution
  • Proven ability to provide day-to-day guidance and technical support to Claims Examiners and lead a team
  • Strong communication and relationship-building skills with clients, claimants, vendors, and internal staff
  • Knowledge of state laws and company/client guidelines for determining compensability and reserving

Responsibilities

  • Provide guidance, support, and supervisory direction to Claims Examiners on the Tower/Venture Leasing Team, while managing a reduced caseload of 50-75 Auto files including No-Fault exposure claims
  • Investigate claims timely and determine compensability based on state law and established guidelines; communicate with clients, claimants, providers, and vendors regarding claims issues
  • Manage reserves within company guidelines and approve authority requests for direct reports; settle and/or finalize claims as designated
  • Maintain diary system, conduct independent file reviews, and report status and any injury trends or safety concerns to the Area Manager and clients

Key facts

Other skills

  • Decision Making
  • Team Leadership
  • Communication
  • Record Keeping
  • Time Management
  • Mentorship
  • Social Skills
  • Computer Literacy
  • Problem Solving

About the company

TRISTAR Insurance Group logo

TRISTAR Insurance Group

Insurance

TRISTAR began as an insurance program manager and medical malpractice claims administrator in 1987. Workers compensation claims management services were added in our offerings in 1989, and the Company was renamed TRISTAR Risk Management in 1995. As managed care and benefits administration services were added to our offerings, the organization grew into TRISTAR. We are the largest privately held third party claims administrator in United States. We empower more than 1,000+ professionals in offices throughout the United States, focusing business operations in three divisions: property casualty claims management, benefits administration, and managed care services. We are true to our values of RESPECT, INTEGRITY, TRUST, and EXCELLENCE, making the right choices both financially and ethically. At TRISTAR we strive to create an environment of respect, wherein all of us are encouraged to learn and to grow, to provide exceptional service to our clients and in turn to enjoy the satisfaction that comes from a job well done. We believe that to provide real service, we must contribute something which cannot be bought or measured with money: sincerity and integrity. At TRISTAR, you help create a world in which together we "transform risk into opportunity".

Company details

Company typeSME
IndustryInsurance
Company size501 - 1000

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Job description

POSITION SUMMARY: Under the oversight of the Area Manager, the Claims Examiner III – Team Leader reports to the Claim Supervisor and/or Area Manager and is responsible for managing all aspects of Auto Liability and PIP/No-Fault claims from inception through resolution, within established authority and company guidelines.

In addition to maintaining an active caseload, the Team Leader provides day-to-day guidance and technical support to Claims Examiners, ensuring consistency, quality, and adherence to best practices. This role requires frequent interaction with clients, claimants, TRISTAR management, and internal staff. The Team Leader may also assist in mentoring and supporting Claims Examiners who report functionally to the role, while partnering with the Supervisor on escalations, training, and performance-related matters.

 

 

DUTIES AND RESPONSIBILITIES:

 

  • Provides guidance, support and some supervisory directions to TRISTAR adjusters on the Tower/Venture Leasing Team whose duties are similar to those outlined above for claims they are assigned by the Claims Examiner III Team Leader *
  • Help to establish procedures for American Arbitration Association to help reduce costs and improve process
  • Effectively manages a reduced caseload of approximately 50-75 Auto files, including large No Fault PIP exposure reportable claims
  • Investigates and conducts investigation in a timely manner for claims assigned. *
  • Determines compensability of claims based upon state law and in accordance with established Company and client guidelines. *
  • Communicate with clients, claimants, providers, and vendors regarding claims issues. *
  • Computes and set reserves within Company guidelines. Authority Limits are larger than
 

those allowed for Claims Examiner I and Claims Examiner II. *

  • Approves authority requests of direct repots for claims assigned and directs them to obtain authority as designated
  • Settles and/or finalizes all claims assigned 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 assigned. *
  • Communicates appropriate information promptly to the Area Manager and client to resolve claims efficiently, including any injury trends or other safety related concerns. *
  • Adheres to all Company policies and procedures. *
  • Conduct file reviews independently. *
  • Other duties as assigned.

 

* Essential job function.

 

 

EQUIPMENT OPERATED/USED: Computer, and other office equipment.

 

 

SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire when on video or attending client meetings.

 

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MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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