Claims TPA Liaison - Worker's Compensation

The Jonus Group•Omaha, NE

1d•$75,000 - $95,000•Remote

About The Position

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.

Requirements

Bachelor’s degree required; industry designations such as AIC, SCLA, or CPCU are a plus.
Active adjuster license with confirmation of home state license.
3-5 years of experience in adjusting workers' compensation claims, with multi-jurisdictional knowledge preferred.
Large loss injury litigation experience.
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.

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.