Claims TPA Liaison - Worker's Compensation

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: $75,000 - $90,000 per year (up to $95,000 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: Bachelor’s 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.