Claims TPA Liaison Worker's CompensationThe Jonus Group • Omaha, Nebraska, USA

Claims TPA Liaison Worker's Compensation

The Jonus Group • Omaha, Nebraska, USA

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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.

#LI-BC1

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

Employment Type : Full-Time

Experience : years

Vacancy : 1

Yearly Salary Salary : 75000 - 90000

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Worker Compensation • Omaha, Nebraska, USA

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