Workers' Compensation TPA Oversight Specialist

RLI Insurance Company•Peoria, IL

6d•$84,749 - $121,191•Hybrid

About The Position

This role oversees, rather than directly handles, workers’ compensation claims managed by an external third-party administrator (TPA), with particular attention to higher-exposure claims. The specialist monitors and helps direct the quality and strategy of the TPA’s claim adjustment, ensuring claim strategies, reserves, and resolution paths align with RLI standards, mitigate risk, and support optimal outcomes. The role reviews claims and TPA performance, collaborates with internal claim operations and leadership, and communicates with underwriters and other stakeholders. It also maintains awareness of regulatory and jurisdictional requirements affecting claim strategy and supports related projects, audits, and performance reviews as needed.

Requirements

Typically requires a bachelor’s degree in business administration, insurance, or a related field.
Four or more years of workers’ compensation claims-handling experience, including experience with complex and litigated claims.
Two or more years of experience providing TPA oversight through an insurance carrier, self-insured retention program, self-insured organization, or equivalent environment, including monitoring TPA performance, conducting claim reviews, and ensuring adherence to claims-handling standards and service expectations.
Experience evaluating claim handling, identifying areas of concern, and working with TPAs or other claims professionals to drive appropriate claim outcomes.
Ability to proactively and strategically assess workers’ compensation claims and TPA claim management.
Demonstrated knowledge of workers’ compensation claims practices, including investigation, reserving, litigation management, settlement strategy, and regulatory compliance.
Strong analytical and critical-thinking skills, including the ability to evaluate claim handling against 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.
Familiarity with workers’ compensation jurisdictional nuances and vendor-management best practices.

Nice To Haves

Prior supervisory, team lead, or claims management experience.
Experience overseeing complex or high-exposure workers’ compensation claim portfolios.

Responsibilities

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

Benefits

Annual bonus plans.
Employee stock ownership plan (ESOP).
401(k) with automatic 3% company contribution.
Annual 401(k) and ESOP profit-sharing contributions of up to 15% of eligible earnings.
Paid time off and holidays.
Paid volunteer time off.
Parental and family care leave.
Flexible and hybrid work arrangements.
Fitness center discounts and a free virtual fitness platform.
Employee assistance program.
Medical, dental, and vision benefits.
Flexible spending and health savings accounts.
Group life and AD&D insurance equal to 2x base salary.
Voluntary life, critical illness, and accident insurance available for purchase.
Short-term and long-term disability benefits.
Training and certification opportunities.
Tuition reimbursement.
Education bonuses.
RLI covers the cost for most professional development programs; employees typically earn a bonus upon successful completion of approved courses and certifications.