Workers Compensation TPA Manager

At Coaction, we’re a unique mix of leaders, achievers, thinkers, and team players with a high-performance mindset and a diverse skillset. We bring our industry expertise together to continually push the boundaries of what insurance can be for our clients.

Overview:

The Manager of Workers Compensation Claims oversees two Third Party Administrators (TPAs) and plays a crucial role in ensuring effective management and oversight of claims handling processes. This position requires attention to detail, strong analytical skills, professional communication, and the ability to collaborate with various internal and external stakeholders. This job description outlines the essential responsibilities and qualifications for the role. Successful candidates will possess a complementary combination of technical expertise, leadership abilities, and a commitment to maintaining high standards of claims management excellence.

Responsibilities:

• Oversee Third Party Administrators (TPAs) to ensure adherence to established protocols, guidelines for claims handling, and application of financial authority.
• Provide guidance and support to the TPAs in complex claims investigations, coverage assessments, and claim resolution processes.
• Conduct regular reviews and scheduled audits of TPA performance to assess compliance with service level agreements and industry best practices.
• Ensure that TPA claims handlers are appropriately skilled and licensed as required by claim type, volume, severity, and statutory requirements.
• Ensure the timely and high-quality completion of large claim reports.
• Assist in the development and implementation of strategies to improve claims management efficiency and effectiveness.
• Robust collaboration with internal stakeholders, including Underwriting partners, internal audit, legal counsel, reinsurance, and senior management, to provide updates on TPA performance, specific claim details, general claim issues, and claim status.
• Serve as a liaison between the company and TPAs to address any issues or concerns promptly and effectively.
• Meet with and stay in close contact with brokers and insureds to ensure we are delivering quality claims service.
• Monitor claims activity and trends to identify areas for improvement and risk mitigation.
• Stay current with industry developments, regulatory changes, and emerging trends in workers compensation claims management.
• Coordinate with Claims Operations for efficient claim support workflow and high-quality service.
• Monitor claims handling for higher-severity and complex cases.
• Serve as the claims contact for key accounts and programs in which the Manager will perform various account or program management tasks including:
  • Preparing for and attending claim reviews
  • Analyzing claims data and meeting with members of other departments to discuss account status.
  • Meeting with and making presentations to account or program representatives.
• May be called upon to perform other tasks and duties within the claims department or company as dictated by business needs.

Qualifications:

• 5+ years of experience in Workers Compensation claims handling in multiple jurisdictions
• 2+ years of claims management experience, preferably with TPA oversight experience
• Extensive experience with WC claims in California, Florida, and New York
• Bachelor’s degree
• Strong understanding of workers' compensation laws, regulations, and industry standards.
• Excellent analytical and problem-solving skills, with the ability to interpret complex data and make informed decisions.
• Exceptional communication and interpersonal skills, with the ability to effectively collaborate with internal and external stakeholders.
• Insurance designations, AIC-M, ARM, SCLA, or CPCU a plus.
• Extensive experience with managing Entertainment, Media, and DICE policies with an understanding of scaffold, USL&H/DBA, and construction exposure.
• Proven ability to manage multiple priorities in a fast-paced environment and meet deadlines consistently.
• Proficiency in Microsoft Office Suite and claims management software.
• Able to travel for mediations, settlement conferences, and trials as needed.

**This is not a fully remote position. Applicants must sit in our Morristown, NJ office on our hybrid work schedule.**

Salary range specific to for this role : $96,000-$161,000 + discretionary incentive bonus + benefits depends on various factors including, without limitation, individual and organizational performance. The offered rate of compensation will be based on individual education, experience, and qualifications.  In addition, employees are eligible for standard benefits package including paid time off, medical, dental and retirement.

Equal Opportunity Employer

Coaction is an Equal Employment Opportunity employer. Coaction’s policy is not to discriminate against any applicant or employee based on race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, and genetic information, or any other basis protected by applicable law. Coaction also prohibits harassment of applicants or employees based on any of these protected categories.

If your application is selected, you will receive an email directly from the Coaction Recruiting Team at [email protected] asking you to contact a member of the Coaction Recruiting Team. Any other method of contact may be fraudulent.