FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Workers' Compensation TPA Oversight Specialist
RLI Insurance Company. Review higher exposure workers’ compensation claims managed by the TPA for legal and RLI standards compliance .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in workers' compensation claims management, including oversight of Third-Party Administrators (TPAs), compliance with legal standards, and strategic evaluation of claims handling. Proficient in analyzing complex claims, ensuring adherence to industry regulations, and providing actionable feedback to improve claim outcomes.
Highest-signal resume keywords
Workers' Compensation Claims HandlingThird-Party Administrator (TPA) OversightClaims Management ExperienceRegulatory Compliance KnowledgeAnalytical and Critical Thinking Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims InvestigationLitigation ManagementSettlement StrategyReserve Adequacy AssessmentClaim Review and ApprovalPerformance MonitoringData ReviewRegulatory Requirements KnowledgeComplex Claims HandlingVendor Management Best Practices
Soft Skills
Clear Communication SkillsAttention to DetailProactive Problem SolvingTime ManagementIndependent Work Ability
Industry Keywords
Workers' CompensationClaims Handling StandardsSelf-Insured Retention (SIR)Insurance CarrierJurisdictional Nuances
About the role
Key responsibilities & impact- Review higher exposure workers’ compensation claims managed by the TPA for legal and RLI standards compliance
- 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 ensure timely administration and resolution of claims
- Review and approve reserve requests above the TPA’s authority
- Coordinate with RLI Claim operations staff on claim setup, processing, payment, and resolution
- Provide internal stakeholders with feedback on TPA claim-handling performance, improvement opportunities, and risks
- Collaborate with internal claim leadership on TPA file audits and performance reviews
- Communicate with underwriters about workers’ compensation claims and industry trends
- Monitor regulatory and jurisdictional requirements affecting claim strategy or handling
- Support special projects involving TPA oversight, claim quality, or claim data review
- Monitor and help direct the quality and strategy of the TPA’s adjustment of workers’ compensation claims rather than directly handling claims
Requirements
What you’ll need- Typically requires a bachelor’s degree in business administration, insurance, or a related field
- Four (4) or more years of workers’ compensation claims handling experience, including experience with complex and litigated claims
- Two (2) or more years of experience providing Third-Party Administrator (TPA) oversight through an insurance carrier, self-insured retention (SIR) program, self-insured organization, or equivalent environment
- Experience monitoring TPA performance, conducting claim reviews, and ensuring adherence to established 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
- Prior supervisory, team lead, or claims management experience preferred
- Experience overseeing complex or high-exposure workers’ compensation claim portfolios preferred
- Ability to proactively and strategically assess WC claims and TPA’s claim management
- Demonstrated knowledge of workers’ compensation claims practices, including claim investigation, reserving, litigation management, settlement strategy, and regulatory compliance
- 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
- Familiarity with jurisdictional nuances in WC and best practices for vendor management
Benefits
Comp & perks- 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