TPA Claims Specialist III

General Description Senior Level Workers' Compensation claim adjuster. Responsibilities Advanced knowledge of Workers' Compensation claims function and processes. Ability to effectively communicate with internal and external customers. Expert understanding of workers compensation or disability claims management, strategies, resolution techniques and adjusting. Technical & administrative capability to adjust lost time, utilizing the features of the TPA claim management systems. Participates in claim advocacy and negotiations, including claim denials, reserving files, and claim reporting, issuing payments, attending hearings, conciliation or mediation and filing of state forms. Determine compensability of the claim as it relates to the worker compensation jurisdiction. Review and approval of loss time, medical services and expenses to be paid of the claims file. Plan and attend claim reviews with clients, carriers and auditors. Negotiate and recommend claim file settlements to the client. Identify client issues, build a plan toward resolution, execute and manage internal and external expectations effectively. Analyze claims based on the TPA best practices as outlined in the "Policy and Procedures" manual. Implement new business with "Special Account Instructions". Understand the financial impact of losses. Communicate with internal resources to explain results and help develop improvement for risk management plans. Develop high-quality output documents for internal resources, clients and carriers. Understand client business issues. Attend sales presentations. Requirements & Qualifications Must have Massachusetts Work's Compensation jurisdictional experience. Cases 100% Massachusetts. Ideal candidate will have a minimum of 8-15 years of Workers' Compensation claims experience. College degree preferred; high school diploma or graduate-equivalent degree required. Expert in MS Office suite of products, especially MS Excel. Superior written and oral communication skills. Ability to lead a team and work well in a team environment. Must have expert analytical thinking and problem-solving skills. Superior organizational skills required. Expert negotiation skills required. Benefits and Compensation Competitive pay with incentive structure: $73,000 – $90,000. Health, wellness, dental, and vision insurance. 401(k) retirement plan. Flexible spending and health savings accounts. Short- and long-term disability insurance. Life insurance. Paid time off, paid family leave, and paid holidays. #J-18808-Ljbffr USI Insurance Services