Claims TPA Liaison Worker's Compensation
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Job Location:
Yearly Salary:
Posted on:
20 hours ago
Vacancies:
1 Vacancy
Job Summary
Job Description
Claims TPA Liaison - Workers Compensation
Job Summary
Seeking a dedicated and experienced Claims TPA Liaison specializing in Workers Compensation to join a team. This is a fully remote full-time position that offers the opportunity to work with a dynamic and professional team. The ideal candidate will provide direct oversight of Third-Party Administrator (TPA) claim administration and act as a key communicator between the TPA policyholders legal teams and internal departments. The role requires a strong technical understanding of workers compensation claims and a commitment to delivering superior customer service.
Compensation Package
- Salary Range: $75000 - $90000 per year (up to $95000 for highly qualified candidates)
- Comprehensive benefits package including:
- Medical (PPO/HDHP) vision disability and life insurance
- Enhanced dental plan with orthodontia coverage
- Generous PTO plan and paid company holidays (including 4 floating holidays)
- Paid parental leave
Responsibilities
- Oversee TPA-handled claims including investigation reserving medical and disability management coverage decisions compensability determinations and settlements.
- Provide strategic direction to TPA adjusters and defense counsel to develop proactive litigation strategies.
- Monitor TPA compliance with claim handling procedures including nurse case management return-to-work programs legal processes settlements and reserving.
- Communicate with policyholders during investigations to gather additional information and resolve inquiries.
- Consult with legal teams to clarify coverage questions and provide guidance to the TPA.
- Resolve routine and complex TPA claim and coverage questions providing claim direction as needed.
- Monitor claims for compliance with medical/disability guidelines and recommend appropriate resources.
- Participate in conference calls with TPA and defense counsel on complex claims with significant exposure.
- Conduct TPA audits to evaluate the quality of work and claim outcomes.
- Assist with process improvements including the development of enhanced TPA workflows and methods.
- Handle escalated TPA issues and special projects as assigned.
- Support the Claims Manager with day-to-day TPA operations including funding requests.
Qualifications/Requirements
- Education: Bachelors degree required; industry designations such as AIC SCLA or CPCU are a plus.
- Licensing: Active adjuster license with confirmation of home state license.
- Experience:
- 3-5 years of experience in adjusting workers compensation claims with multi-jurisdictional knowledge preferred.
- Large loss injury litigation experience.
- Skills:
- Strong technical understanding of workers compensation claims investigation compensability insurance coverages and negotiation.
- Excellent verbal and written communication skills.
- Strong analytical organizational and time management abilities.
- Proficiency in MS Word Excel and internet applications.
- Ability to work independently in a fast-paced collaborative virtual office environment.
- Highly attentive to detail and able to execute sound judgment in sensitive situations.
- Strong interpersonal and negotiation skills.
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Key Skills
- Presentation Skills
- Time Management
- Clinical Research
- Communication skills
- GCP
- Infusion Experience
- Managed Care
- Hospice Care
- Conflict Management
- Clinical Trials
- Research Experience
- Home Care
About Company
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