Program Claim Manager, Workers Compensation
USFull-TimeManager
Salary87,600 - 120,000 USD per year
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Job Details
- Experience
- 7–10+ years
- Required Skills
- Negotiation
Requirements
- 7–10+ years of experience handling or litigating complex workers’ compensation claims in insurance or related environments
- Strong technical expertise in claims management, litigation strategy, and insurance policy interpretation
- Experience working with Third Party Administrators (TPAs), MGAs, or similar claims outsourcing models
- Strong understanding of coverage analysis, reserving practices, and risk transfer concepts
- Excellent negotiation skills with the ability to influence outcomes while maintaining strong professional relationships
- Strong communication skills, both written and verbal, with the ability to engage internal and external stakeholders effectively
- Ability to manage multiple complex claims and adapt to shifting priorities in a fast-paced environment
- Proficiency in digital or paperless claims management systems and related tools
- Strong analytical thinking and ability to evaluate claim exposures and financial implications
- Texas adjuster license preferred
- Professional designations such as CPCU, AIC, or SCLA are strongly preferred
- Bachelor’s degree or equivalent professional experience in insurance, risk management, or related field is an advantage
Responsibilities
- Provide oversight, guidance, and performance feedback to Third Party Administrators (TPAs) managing workers’ compensation claims programs
- Manage account-level claims performance, ensuring alignment with service standards, litigation guidelines, and regulatory requirements
- Lead onboarding and implementation processes for new TPA or MGA/TPA program partnerships
- Conduct claims due diligence during partner evaluation and program approval processes
- Monitor claim handling quality, including investigations, reserving practices, expert utilization, and legal strategy execution
- Evaluate coverage issues and risk transfer opportunities, ensuring appropriate interpretation of policy terms and exposures
- Collaborate with analytics teams to assess TPA and program performance and communicate findings to stakeholders
- Draft, review, and maintain service instructions and operational guidelines for assigned programs
- Ensure compliance with internal standards, regulatory requirements, and best practices across all TPA operations
- Perform claim audits and contribute to continuous improvement of claims governance frameworks
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