Workers' Compensation Claims TPA Liaison

Workers' Compensation Claims TPA Liaison

The Workers’ Compensation Claims TPA Liaison at biBerk Business Insurance provides direct oversight of Third-Party Administrator (TPA) claim administration and facilitates communication between the TPA, policyholders, legal, and other internal departments. This role's mission is to provide superior customer service and ensure TPA claim outcomes are within best practices by utilizing technical claims expertise and providing guidance to the TPA. This position reports to the Workers’ Compensation Claims Manager.

This is a full-time remote position and may require occasional travel for mediations, trainings, trials, or other department meetings.

Job Responsibilities

• Direct management of TPA handled claims, including oversight of investigation, reserving, medical and disability management, coverage decisions, compensability determinations, and settlements.
• Provide strategic direction to TPA adjusters and defense counsel to formulate proactive litigation strategies.
• Monitor TPA’s compliance with claim handling procedures, including nurse case management, return to work, legal, settlement, and reserving.
• Alert Underwriting to relevant information and safety concerns.
• Contact policyholders as needed during the investigation phase to clarify and/or gather additional information required to process claims and/or resolve inquiries.
• Consult legal to clarify coverage questions and provide guidance to TPA.
• Resolve routine and complex TPA claim and coverage questions with a goal of providing claim direction to TPA.
• Resolve date of loss discrepancies identified on the DOL Mismatch report.
• Extend reserve and settlement authority to TPA, alerting management to over-authority requests and complex claims.
• Monitor TPA claims to identify files that exceed medical/disability guidelines or treatment parameters. Recommend TPA engage medical resources as appropriate.
• Participate in conference calls with TPA and defense counsel on complex claims with significant exposure.
• Generate TPA inventory reports and monitor aging claims and/or claims with significant exposure.
• Provide guidance to TPA to ensure claims are proactively managed to resolution.
• Respond to daily emails from the TPA requiring assistance.
• Perform TPA audits to evaluate quality of work and claim outcomes.
• Ensure appropriate resources (NCM, FNCM, subrogation, legal, etc) are timely assigned to TPA claims.
• Monitor claim assignment workflow to ensure claims are assigned to TPA efficiently.
• Partner with Claims Technician to resolve TPA system data errors.
• Assist with process improvement in the development of enhanced TPA workflows and methods.
• Prepare ad hoc TPA reports.
• Handle escalated TPA issues and projects as assigned.
• Assist Claims Manager with day-to-day TPA operations, including TPA funding requests.
• Other tasks and special projects as assigned.

Qualifications

• Active adjuster license.
• 3-5 years experience adjusting workers’ compensation claims (multi-jurisdictional knowledge a plus).
• Technical understanding of workers’ compensation claims investigation techniques, compensability, insurance coverages, and negotiation skills.
• Large loss injury litigation experience.
• Self-motivated with the ability to work independently to meet deadlines.
• Excellent verbal and written communication skills.
• Ability to multi-task and work in a fast-paced, collaborative, virtual office environment.
• Strong analytical, organizational, and time management skills.
• Proficiency with MS Word, Excel and internet applications.
• Highly attentive to details.
• Able to work under pressure and execute good judgment in sensitive situations.
• Strong interpersonal skills.
• Strong negotiation skills.

Education

• BA/BS degree required.
• AIC, SCLA, CPCU or other industry designation a plus.

About biBerk Business Insurance

biBerk allows commercial insurance buyers to obtain coverage from insurers of the Berkshire Hathaway group of Insurance Companies, a top-tier capitalized insurance group. Our ultimate parent, Berkshire Hathaway Inc., holds diversified interests across various industries. Policies are primarily underwritten by Berkshire Hathaway Direct Insurance Company (BHDIC), an AM Best rated A++ insurer domiciled in Omaha, Nebraska.

BHDIC and biBerk focus on providing small business owners with direct, affordable, and trustworthy insurance. We offer a comprehensive benefits package, including medical, vision, enhanced dental, generous PTO, paid holidays, parental leave, 401(k) with company match, education assistance, service recognition, wellness initiatives, and various voluntary benefits and discounts.

Key skills/competency

• Workers' Compensation Claims
• TPA Oversight
• Claim Administration
• Litigation Strategy
• Compliance Monitoring
• Policyholder Communication
• Negotiation Skills
• Coverage Determinations
• Medical Management
• Process Improvement