Offer summary

Qualifications:

Active adjuster license required., 3-5 years of experience adjusting workers’ compensation claims, preferably with multi-jurisdictional knowledge., Strong technical understanding of claims investigation, compensability, and negotiation skills., Excellent verbal and written communication skills, with strong analytical and organizational abilities..

Key responsibilities:

Directly manage TPA handled claims and oversee various aspects of claim administration.

Provide strategic direction to TPA adjusters and monitor compliance with claim handling procedures.

Consult with legal and policyholders to clarify coverage questions and gather necessary information.

Perform audits and generate reports to evaluate TPA performance and assist with process improvements.

Job description

The WC TPA Liaison provides direct oversight of Third-Party Administrator (TPA) claim administration and facilitates communication between the TPA, policyholders, legal, and other internal departments. The WC TPA Liaison’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.

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 adjuster/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 improved 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
Excellent written and verbal communication skills
Strong organizational and computer skills
Strong negotiation skills

About Us

biBerk is where commercial insurance buyers can obtain coverage for their businesses from insurers of the Berkshire Hathaway group of Insurance Companies, one of the best capitalized insurance groups in the world. Our ultimate parent, Berkshire Hathaway Inc. (berkshirehathaway.com) is a holding company with diversified interests in a host of industries, including insurance, energy, transportation and manufacturing. Most policies issued through biBerk.com will be underwritten by Berkshire Hathaway Direct Insurance Company ("BHDIC"), which is an AM Best rated A++ insurer.

BHDIC is domiciled in Omaha, Nebraska. BHDIC and the team at biBerk are focused on helping small business owners quickly and easily buy affordable insurance directly from a financially strong insurance company they can trust.

Some highlights of our benefits are:

Great work environment with growth opportunity
Subsidized downtown parking (for in-office positions)
Competitive compensation
Generous amounts of vacation and sick time
Closed on major holidays
401(k) with company match
A fantastic healthcare package
Tuition reimbursement after 6 months of employment
Service recognition after 5 years of employment

In accordance with pay transparency laws and regulations, the following good faith compensation range estimate is being provided. The salary range for this position is $75,000- $95,000 per year. Final compensation will be based on candidate qualifications, geographic location, and other considerations permitted by law.

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