Senior Workers' Compensation TPA Oversight Specialist |...

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 experienceInsurance Carrier or TPA experience is requiredTPA oversight experience is a plusEffective organizational skills and ability to work independentlyBachelor's Degree strongly desiredSalary/Benefits:$90,000 to $110,000+ base salary plus Annual BonusEmployer matching 401(k) planExtremely competitive Medical, Dental, Vision and Life plansEmployer Contribution to HSAGenerous PTOAdditional Long-Term Incentive PlansFlexible work schedule and ability to work from home

Created: 2024-11-07