索赔TPA联络员 - 工伤补偿

The Workers’ Compensation Claims TPA Liaison provides direct oversight of Third-Party Administrator (TPA) claim administration and facilitates communication between the TPA, policyholders, legal, and other internal departments. The WC TPA Liaison’s mission is to provide superior customer service and ensure TPA claim outcomes are within best practices by utilizing technical claims expertise and providing guidance to the TPA. This position reports to the Workers’ Compensation Claims Manager.
Location: This is a full-time remote position. This position may require occasional travel to attend mediations, trainings, trials and/or other related department meetings.
Job Responsibilities

• Direct management of TPA handled claims, including oversight of investigation, reserving, medical and disability management, coverage decisions, compensability determinations, and settlements

• Provide strategic direction to TPA adjuster/defense counsel to formulate proactive litigation strategies

• Monitor TPA’s compliance with claim handling procedures, including nurse case management, return to work, legal, settlement, and reserving

• Alert Underwriting to relevant information and safety concerns

• Contact policyholders as needed during the investigation phase to clarify and/or gather additional information required to process claims and/or resolve inquiries

• Consult legal to clarify coverage questions and provide guidance to TPA

• Resolve routine and complex TPA claim and coverage questions with a goal of providing claim direction to TPA

• Resolve date of loss discrepancies identified on the DOL Mismatch report

• Extend reserve and settlement authority to TPA, alerting management to over-authority requests and complex claims

• Monitor TPA claims to identify files that exceed medical/disability guidelines or treatment parameters. Recommend TPA engage medical resources as appropriate.

• Participate in conference calls with TPA and defense counsel on complex claims with significant exposure

• Generate TPA inventory reports and monitor aging claims and/or claims with significant exposure

• Provide guidance to TPA to ensure claims are proactively managed to resolution

• Respond to daily emails from the TPA requiring assistance

• Perform TPA audits to evaluate quality of work and claim outcomes

• Ensure appropriate resources (NCM, FNCM, subrogation, legal, etc) are timely assigned to TPA claims

• Monitor claim assignment workflow to ensure claims are assigned to TPA efficiently

• Partner with Claims Technician to resolve TPA system data errors

• Assist with process improvement in the development of enhanced TPA workflows and methods

• Prepare ad hoc TPA reports

• Handle escalated TPA issues and projects as assigned

• Assist Claims Manager with day-to-day TPA operations, including TPA funding requests

• Other tasks and special projects as assigned

Qualifications

• Active adjuster license

• 3-5 years experience adjusting workers’ compensation claims (multi-jurisdictional knowledge a plus)

• Technical understanding of workers’ compensation claims investigation techniques, compensability, insurance coverages, and negotiation skills

• Large loss injury litigation experience

• Self-motivated with the ability to work independently to meet deadlines

• Excellent verbal and written communication skills

• Ability to multi-task and work in a fast-paced, collaborative, virtual office environment

• Strong analytical, organizational, and time management skills

• Proficiency with MS Word, Excel and internet applications

• Highly attentive to details

• Able to work under pressure and execute good judgment in sensitive situations

• Strong interpersonal skills

• Excellent written and verbal communication skills

• Strong organizational and computer skills

• Strong negotiation skills

Education:

• BA/BS degree required

• AIC, SCLA, CPCU or other industry designation a plus

About Us
biBerk is where commercial insurance buyers can obtain coverage for their businesses from insurers of the Berkshire Hathaway group of Insurance Companies, one of the best capitalized insurance groups in the world. Our ultimate parent, Berkshire Hathaway Inc. (berkshirehathaway.com) is a holding company with diversified interests in a host of industries, including insurance, energy, transportation and manufacturing. Most policies issued through biBerk.com will be underwritten by Berkshire Hathaway Direct Insurance Company ("BHDIC"), which is an AM Best rated A++ insurer.
BHDIC is domiciled in Omaha, Nebraska. BHDIC and the team at biBerk are focused on helping small business owners quickly and easily buy affordable insurance directly from a financially strong insurance company they can trust.
BHDIC is excited to announce our comprehensive benefits package with some new and enhanced features for 2026 that include:

• Medical (PPO/HDHP), vision, disability, and life insurance.

• Enhanced dental plan with orthodontia coverage in addition to a standard plan.

• Generous PTO plan for all benefit-time eligible employees.

• Paid company holidays and 4 floating holidays.

• Paid parental leave.

• Employee Retirement Savings Plan/401(k) with company match and immediate vesting.

• Education Assistance Program that offers 100% upfront tuition reimbursement after 6 months of service for approved degree programs.

• Service Recognition Program that provides a monetary award to be used toward a vacation every 5 years of employment.

• Wellness Initiatives that include Fitness Center and Weight Watchers Reimbursement programs.

• Voluntary benefits that include accident, critical illness, and hospital indemnity.

• Employee discount and rewards program on travel, tickets, electronics, home, and more.

In accordance with pay transparency laws and regulations, the following good faith compensation range estimate is being provided. The salary range for this position is $75,000-$90,000 per year. Final compensation will be based on candidate qualifications, geographic location, and other considerations permitted by law.
Originally posted on Himalayas