Workers' Third Party Administrator; TPA Claims Manager

All Jobs >
Workers' Compensation Third Party Administrator (TPA) Claims Manager

Workers' Compensation Third Party Administrator (TPA) Claims Manager
Fully Remote
• BHDIC Claims

Full-time

Description

The Claims Manager, Workers’ Compensation TPA Claims, oversees a team responsible for managing third‑party administrator performance across multiple Workers’ Compensation programs. This fully remote leadership role within the BHDIC Claims Department requires deep expertise in workers’ compensation claims handling and regulatory requirements. The position is accountable for TPA performance outcomes, operational oversight, and escalation management. Key responsibilities include guiding TPAs to consistently follow claims service level agreements and monitoring compliance with established policies, procedures, and standards to ensure strong oversight and control.

The role reports to the Director of Claims.

• Oversee assigned TPA relationships and ensure consistent execution of oversight and control measures
• Lead and develop a team of Workers’ Compensation TPA Liaisons, establishing priorities to ensure tasks and performance goals are met
• Authorize reserve/settlement requests within authority and prepare requests that exceed authority for internal senior leadership roundtable
• Provide technical expertise and oversight through regular file reviews, audits, and authority approvals to ensure TPAs follow best practices and internal standard
• Oversee team resolving TPA data feed errors to ensure accurate financial reporting
• Build and maintain strong relationships with cross-functional teams, TPAs, vendors, brokers, policyholders, and legal partners
• Participate in internal and external meetings, including weekly TPA client meetings and quarterly claim reviews
• Serve as an escalation point for issues impacting the customer experience and communicate expectations, procedures, and protocols to TPAs
• Evaluate TPA performance through audits; drive remediation plans when performance does not meet key performance metrics and service‑level agreements
• Report account changes or vendor concerns to ensure service level agreements are met
• Performs additional projects and duties as assigned

• Bachelor’s Degree required
• 10+ years of experience handling multi‑jurisdictional Workers’ Compensation Claims
• Prior leadership experience required
• Demonstrated experience working with third‑party administrators
• Strong governance, oversight, and risk assessment capabilities
• Experience in conflict resolution and the ability to de‑escalate tense situations; comfortable in a role that requires negotiation
• Deliver exceptional customer service to insureds, brokers, and TPAs
• Advanced written and verbal communication skills, including the ability to communicate effectively with TPAs, senior leadership, legal, and compliance
• Proficiency in understanding metrics that impact overall department objectives
• Proficiency with Microsoft Office tools (Excel, Teams, PowerPoint, Word, Outlook)
• Strong organizational skills with the ability to manage multiple priorities and initiatives concurrently
• Ability to travel as needed

• Medical (PPO/HDHP), vision, disability, and life insurance.
• Enhanced dental plan with orthodontia coverage in addition to a standard plan.
• Generous PTO plan for all benefit‑time eligible employees.
• Paid company holidays and 4 floating holidays.
• Paid parental leave.
• Employee Retirement Savings Plan/401(k) with company match and immediate vesting.
• Education Assistance Program that offers 100% upfront tuition reimbursement after 6 months of service for approved degree programs.
• Service Recognition Program that provides a monetary award to be used toward a vacation every 5 years of employment.
• Wellness Initiatives that include Fitness Center and Weight Watchers Reimbursement programs.
• Voluntary benefits that include accident, critical illness, and hospital indemnity.
• Employee discount and rewards program on travel, tickets, electronics, home, and more.

In accordance with pay transparency laws and regulations, the following good faith compensation range estimate is being provided. The starting salary range for this position is $115,000 to  per year. Final compensation will be based on candidate qualifications, geographic location, and other considerations permitted by law.