TPA Claim Examiner - Workers' Compensation (Medical Only)

TPA Claim Examiner - Workers' Compensation

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

General Description:

The TPA Claim Examiner is responsible for ensuring that the segment of non-complex 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 as required under close supervision by the Senior Claim Director
• 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 bringing these issues to the attention of the Senior Claim Director so that necessary remedial actions can be taken
• 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

 Qualifications: 

• Minimum of 3 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 managing and adjusting California workers compensation claims is preferred.
• 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