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TPA Claim Director - Workers' Compensation

Employer
Houston International Insurance Group
Location
Dallas, Texas (US)
Salary
Depends on Experience
Closing date
Jun 18, 2019

View more

Category
Claims, Workers' Compensation
Job Type
Full Time
Career Level
Manager

Job Details

 

TPA Claim Director - Workers' Compensation

**This role can be based in our Dallas, Atlanta or Scottsdale locations.

General Description:

The TPA Claim Director is the person accountable to HIIG for the performance of the TPA claim staff handling worker's compensation claims on behalf of HIIG, its policyholders and insureds. The role is responsible for ensuring that the segment of claims under his/her purview are managed in accordance with HIIG claim handling requirements and standards, all applicable state and regulatory requirements, and meet or exceed HIIG's expectations in the quality of the overall claim outcomes achieved.

 

Job Responsibilities:

  • Manages relationship with Third Party Administrator staff handling the claims within his/her purview and ensures their understanding of HIIG claim handling requirements and performance expectations
  • Directs the activities of the TPA and counsel providing input and direction as required. 
  • Conducts continuous review and oversight of claims managed by the TPA for purposes of:

            Ensuring that claims are handled effectively, evaluated quickly 

            Case reserves appropriately reflect likely outcome

            Identifying any performance issues and compliance gaps and taking actions necessary to                       remediate.

  • Actively monitors, manages and seeks to resolve claims that exceed the TPA's delegated authority
  • Ensures all open claims are effectively brought to resolution at the best possible outcome at the earliest opportunity.
  • Identifies and evaluates additional opportunities  to further reduce the severity and cost of claims Conducts analysis relating to understand the activity and 'behavior' of the claim population(s) under management and reports as required.

 

Qualifications:
 

  • Minimum of 8 years of experience to include direct handling of workers’ compensation claims
  • Has demonstrated a proficient level of understanding of individual state workers compensation and civil laws, claims practices and regulatory requirements
  • Experience with TPA management and oversight
  • A willingness to enhance and grow their depth and understanding of workers’ compensation claims
  • Strong analytical and organizational skills
  • Flexibility to travel
  • Bachelor Degree Required
  • Licenses: Current state adjusting license is required

Desired Skills:

  • Utilize specialized computer software applications. Complete reports and claim histories as needed
  • Demonstrate effective written and verbal communication skills
  • Work independently and demonstrate good business sense
  • Results oriented. A strong focus on execution and getting things done right
  • A self-starter with a high level of professional maturity and a strong sense of urgency
  • Thrives on and is not afraid of challenges
  • Ability to establish and maintain effective working relationships with peers, staff and other functional areas.
  • Ability to drive results by identifying and resolving observed problems within the scope of responsibility

Company

Houston International Insurance Group (HIIG) is a specialty company that provides creative solutions for our clients’ specialized needs and is headquartered in Houston, Texas, with offices across the United States.

 

Company info
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