TPA Claims Specialist II

About the Role

Adjuster of lost and non-lost time claims for workers compensation.

Responsibilities

• Apply advanced knowledge of claims function and processes.
• Effectively communicate with internal and external customers.
• Demonstrate strong understanding of workers compensation or disability claims management, strategies, resolution techniques, and adjusting.
• Enter first reports of injury and adjust lost time and non-lost time claims using TPA claim management systems.
• Participate in claim advocacy and negotiations, including claim denials, reserving files, claim reporting, issuing payments, attending hearings, conciliations, or mediations, and filing state forms.
• Determine compensability of the claim as it relates to the worker compensation jurisdiction.
• Review and approve loss time, medical services, and expenses for claims.
• Plan and attend claim reviews with clients, carriers, and auditors.
• Identify client issues, build resolution plans, and manage internal and external expectations.
• Analyze claims based on TPA best practices outlined in the "Policy and Procedures" manual.

Requirements

• Minimum 5 years of claims adjusting experience.
• College degree preferred; high school diploma or equivalent required.
• Proficient-to-expert in MS Office suite.
• Must be licensed in all jurisdictions handled.
• Superior written and oral communication skills.
• Ability to work well in a team environment.
• Strong analytical thinking and problem-solving skills.
• Strong organizational and negotiation skills.

About the Company

USI is one of the largest insurance brokerage and consulting firms in the world, with approximately $3 billion in revenue and over 10,500 associates across approximately 200 offices nationwide. The company offers a dynamic personal and professional development culture, investing heavily in employee growth and success through unique reward and recognition programs.

USI provides the USI ONE Advantage®, a value proposition delivering robust risk management and benefit solutions with measurable financial impact. This includes Omni, Network, and Enterprise solutions that set USI apart from competitors.

Benefits

• Comprehensive health, welfare, and financial benefits, including medical, dental, and vision.
• 401(k) retirement plan with company contributions.
• Flexible spending and health savings accounts.
• Short- and long-term disability and life insurance.
• Unique employer-sponsored and voluntary programs.
• Generous paid time off policy, paid family leave, and paid holidays.
• Summit Awards program recognizing excellence in brand-building.
• Award-winning wellness program and college scholarships for associates' children.
• Financial assistance in times of need.

Pay

$57,000 - $77,000

Company Culture and Recognition

• Deep community engagement through volunteerism, environmental sustainability, and local non-profit support.
• Award-winning I’m With U diversity and inclusion program, including education, training, and outreach initiatives.
• Nationally recognized as a top insurance employer, including:
  • Insurance Business America’s Top Insurance Employers (2018-2025).
  • Business Insurance’s Best Places to Work in Insurance (2020-2025).
  • Fortune’s Best Workplaces in Financial Services & Insurance (2024-2025).
  • Certified as a Great Place To Work (2024-2025).