TPA Liability Claims Adjuster

TPA Liability Claims Adjuster

Employer:

USI Insurance Services

Role can be worked remotely. Ideally within New York State but we will consider candidates throughout the New England region ONLY. Some travel to client sites is required a couple times per month. NYS Department of Finance Services– Casualty General Adjuster License required.

Supervise activities of 1 claim handler within the third‑party administration (TPA) claims handling department responsible for supervising, processing, paying and resolving liability claims. Supervise staff, providing direction, setting goals, evaluating results and ensuring that overall staff goals are attained. Ensure that ongoing activities are performed according to established policies, procedures and applicable state regulations and carrier/client instructions. Ensure compliance with laws, regulations and guidelines.

• Supervise 1 claim handler including hiring, training, career development, performance reviews and performance improvement plans.
• Supervise the activities of claim handlers within the TPA claims handling unit, ensuring compliance with policies, procedures, legal and regulatory guidelines.
• Supervise staff directly, providing direction, setting goals, evaluating results, and ensuring overall goals are attained. Provide leadership, coaching, counseling, training and guidance to staff and assign responsibilities. Develop and monitor plans to ensure completion of goals and meeting deadlines. Train new staff on department policies, practices and procedures.
• Ensure adherence to policies, procedures, standards and guidelines and coordinate compliance with overall division guidelines and regulatory agencies.
• Supervise ongoing claims activities, including receiving client claims, research and information gathering, payment determination and claims administration. Review claims files for payment appropriateness, policy compliance and timeliness. Determine staff diary dates and review notes for active lost‑time claims. Ensure proper implementation of established policies and procedures.
• Visit clients regularly, maintaining strong business relationships, exchanging information and contributing to ongoing renewal of business. Communicate regularly with production and customer‑service areas regarding account status.
• Assist staff with complex aspects of work as necessary, resolving escalated issues by consulting with staff, management, other departments, outside contacts and clients. Perform claims and other activities personally as workload requires.
• Manage scheduling and assignment of work and activities to ensure key deliverables meet guidelines, assessing internal and external customer needs and delivering services efficiently.
• Review and evaluate activities regularly, ensuring policies and procedures are followed, and provide management with updates on performance and corrective action as necessary.
• Maintain knowledge of current developments in the TPA claims industry, including regulatory issues and guidelines; alert staff to developments and develop recommendations for division management.
• Participate in civic activities to promote growth, development of the community and a positive company image.
• Participate in special projects and perform additional duties as required.
• Contribute to a positive, ethical, and respectful working environment, communicating openly and modeling company culture internally and externally.

• 4‑year degree or equivalent combination of education and work experience required.
• 10–15 years of liability claims experience required (auto and general liability).
• Strong knowledge of liability claims management.
• In‑depth knowledge of legal and regulatory requirements.
• Supervisory skills, with ability to coach, train and motivate staff effectively.
• Supervisory experience required.
• Ability to evaluate data and formulate claims strategy.
• Negotiation skills to resolve large claims at minimum cost.
• Ability to coordinate diverse individuals to resolve claims.
• Highly organized with ability to manage work involving large client volume.
• Strong understanding of claims‑management technology applications.
• Excel…