Workers' Compensation Claim Monitoring Specialist

RLI Insurance Company•Chicago, IL

1d•$71,821 - $102,704•Hybrid

About The Position

This role focuses on oversight rather than direct handling of workers’ compensation (WC) claims. The WC Claim Oversight Specialist will monitor the performance and decision-making of the external third-party administrator (TPA) with particular focus on managing higher exposure WC claims. The goal is to ensure claim strategies, reserve practices, and resolution paths align with RLI’s standards, mitigate risk, and support optimal outcomes. The Claim Oversight Specialist will not direct handle claims in this role. Instead, this role monitors and helps direct the quality and strategy of the TPA’s adjustment of WC claims.

Requirements

Typically requires a bachelor’s degree in business administration, insurance, or a related field
6+ years of related experience handling WC claims, with exposure to complex and litigated files.
Supervisory experience in a WC environment is strongly preferred.
[OR] equivalent level of education and experience
Ability to proactively and strategically assess WC claims and TPA’s claim management.
Strong analytical and critical thinking skills with the ability to evaluate claim handling against WC legal requirements and industry and internal standards.
Clear written and verbal communication skills for summarizing claim concerns and recommendations.
High attention to detail and a proactive approach to identifying potential issues.
Ability to work independently and manage time effectively in a flexible, part-time arrangement.
Familiarity with jurisdictional nuances in WC and best practices for vendor management.

Nice To Haves

Experience with vendor-managed claims or quality assurance oversight is a strong plus.

Responsibilities

Review higher exposure WC claims managed by TPA to ensure compliance with legal requirements and RLI's standards, expectations, and strategic direction.
Identify, address and escalate concerns related to reserve adequacy, litigation strategy, medical management, and settlement positioning.
Review new claims for assignment and confirmation of coverage.
Partner with TPA claim handlers and leadership to ensure WC claims are timely administered and resolved, including review and approval of reserve requests above TPA’s authority.
Coordinate and collaborate with RLI Claim operations staff on the set-up, processing, payment and resolution of WC claims.
Provide timely feedback to internal stakeholders on WC claim handling performance, opportunities for improvement, and potential risks.
Collaborate with internal claim leadership to support file audits or performance reviews of TPA.
Communicate with underwriters regarding WC claims and industry trends.
Maintain awareness of regulatory or jurisdictional requirements that may impact WC claim strategy or handling.
Support special projects related to TPA, claim quality, or claim data review as needed.

Benefits

Annual bonus plans
Employee stock ownership plan (ESOP)
401(k) — automatic 3% company contribution
Annual 401k and ESOP profit-sharing contributions (Up to 15% of eligible earnings)
Paid time off (PTO) and holidays
Paid volunteer time off (VTO) to support our communities
Parental and family care leave
Flexible & hybrid work arrangements
Fitness center discounts and free virtual fitness platform
Employee assistance program
Comprehensive medical, dental and vision benefits
Flexible spending and health savings accounts
2x base salary for group life and AD&D insurance
Voluntary life, critical illness, & accident insurance for purchase
Short-term and long-term disability benefits
Training & certification opportunities
Tuition reimbursement
Education bonuses