TPA Claims Specialist II

About the Role

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

Responsibilities

• Advanced knowledge of claims function and processes.
• Effectively communicate with internal and external customers.
• Strong understanding of workers compensation or disability claims management, strategies, resolution techniques, and adjusting.
• Technical capability to 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 approval of lost time, medical services, and expenses to be paid on claims files.
• Plan and attend claim reviews with clients, carriers, and auditors.
• Identify client issues, build a resolution plan, execute, and manage internal and external expectations effectively.
• Analyze claims based on TPA best practices as outlined in the "Policy and Procedures" manual.

Requirements

• Minimum 5 years of claims adjusting experience.
• College degree preferred but high school diploma or graduate equivalent degree required.
• Proficient-to-expert in MS Office suite of products.
• Must be licensed in all jurisdictions handled.

Skills

• Superior written and oral communication skills.
• Ability to work well in a team environment.
• Strong analytical thinking and problem-solving skills.
• Strong organizational skills.
• Strong negotiation skills.

About the Company

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

USI ONE Advantage® delivers robust risk management and benefit solutions with bottom-line financial impact, setting USI apart from competitors through Omni, Network, and Enterprise elements.

Benefits

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

Pay

$57,000 - $77,000