TPA Claims Specialist III

Overview

Senior Level lost time claim adjuster for workers compensation.

• Advanced Knowledge of 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, conciliations or mediations 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.
• Ability to identify client issues, build a plan towards resolution, execute and manage internal and external expectations effectively.
• Analyzes claims based on the TPA best practices as outlined in the "+"Policy and Procedures"" manual.
• Skill set to implement new business with "Special Account Instructions".
• Understand the financial impact of losses.
• Ability to communicate with internal resources to explain results and help develop improvement for risk management plans.
• Ability to develop high quality output documents for internal resources, clients and carriers
• Understand client business issues.
• Attend sales presentations.
• Act as a team leader with the non lost time claim adjuster and the medical case manager.

• Ideal candidate will have a minimum of 10 - 15 years of claims administration experience.
• College degree preferred but 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.

With approximately $3 billion in revenue and over 10,500 associates across approximately 200 offices nationwide, USI is one of the largest insurance brokerage and consulting firms in the world. At USI, we have created one of the most dynamic personal and professional development cultures in the industry. We invest heavily in our associates, and we take pride in celebrating their growth and success through our one-of-a-kind employee reward and recognition programs.

What truly distinguishes USI as a premier insurance brokerage and consulting firm is the USI ONE Advantage®, a game-changing value proposition that delivers to clients a robust set of risk management and benefit solutions with bottom-line financial impact. USI ONE represents Omni, Network, Enterprise—the three key elements that set USI apart from the competition. Through USI ONE, we develop strategic, timely, and effective risk management and benefit programs in terms that are easy to understand, and we demonstrate how the solutions can have a positive economic impact.

In addition to competitive pay, incentives, and benefits, USI recognizes associates through our Summit Awards program, rewarding excellence in those who build our brand each day. USI offers employee programs that recognize outstanding achievement and help our associates lead healthy, productive lives. We turn care into action with our award-winning wellness program, college scholarships for associates' children, and financial help in times of need.

We are committed to giving back to our local communities and supporting a culture of environmental sustainability. From sharing our time, talent, and resources to support local non-profit organizations, animal shelters, and environmental beautification and restoration projects – to partnering with eco-conscious vendors and taking steps to reduce our own…