Our client, an A-rated Insurance Carrier, is seeking to add a Senior Workers' Compensation Claims TPA Oversight Specialist due to continued growth in the region! This person would be responsible for promptly evaluating and reviewing Pennsylvania and New Jersey Workers’ Compensation claims handled by Third Party Administrators (TPA) for adherence to company’s best claim practices.
In addition, you will provide direction to TPA and act as a liaison between broker, insured, underwriting, loss control and TPA.
Qualified candidates must be well versed in both Pennsylvania and New Jersey Workers’ Compensation Law. This is a fully remote position!
- Responsible for overseeing the investigation, and management of Pennsylvania and New Jersey Workers’ Compensation claims.
- Maintain client specific handling instructions, both internally and with TPA.
- Review / approve reserves on assigned claims.
- Review TPA claim activity and provide direction as appropriate on investigations, follow up, and evaluation of exposure;
facilitate return to work strategy with TPA and insured.
- Audit TPA benefit calculations due and ensures they are paid appropriately.
- Review TPA requests for vendor referrals for reasonableness and ensure ongoing activity for impact to overall outcome of the claim.
- Maintain accurate and timely diaries on all files on an on-going basis.
- Document claim activities, reserve analysis, and summaries of reports in the claim system.
- Review TPA settlement evaluations for authority concurrence.
Requirements :
- 5 - 10+ years of Pennsylvania and New Jersey Workers’ Compensation claims experience
- Insurance Carrier or TPA experience is required
- TPA oversight experience is a plus
- Effective organizational skills and ability to work independently
- Bachelor's Degree strongly desired
Salary / Benefits :
- $90,000 to $110,000+ base salary plus Annual Bonus
- Employer matching 401(k) plan
- Extremely competitive Medical, Dental, Vision and Life plans
- Employer Contribution to HSA
- Generous PTO
- Additional Long-Term Incentive Plans
- Flexible work schedule and ability to work from home
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