Company
Insurance
ProgramClaimManager,WorkersCompensation
Neural analysis suggests this role is
optimal for Senior candidates.
“Program Claim Manager, Workers Compensation. Skills: Workers Compensation claims, Third Party Administrators (TPAs), claims management, litigation strategy, insurance policy interpretation. Provide oversight, guidance, and performance feedback to Third Party Administrators (TPAs) managing workers’ compensation claims programs. Manage account-level claims performance, ensuring alignment with service standards, litigation guidelines, and regulatory requirements. Lead onboarding and implementation ”
What You'll Achieve.
Ensure optimal financial and operational outcomes for claims resolution strategies.
Industry & Context.
evaluate claim exposures; financial implications
Ability to manage multiple complex claims and adapt to shifting priorities in a fast-paced environment.
What They're Looking For.
Must Have
7–10+ years of experience handling or litigating complex workers’ compensation claims in insurance or related environments. Experience working with Third Party Administrators (TPAs), MGAs, or similar claims outsourcing models. Ability to manage multiple complex claims and adapt to shifting priorities in a fast-paced environment. Analytical thinking and ability to evaluate claim exposures and financial implications.
Nice to Have
Texas adjuster license preferred. Professional designations such as CPCU, AIC, or SCLA are strongly preferred. Bachelor’s degree or equivalent professional experience in insurance, risk management, or related field is an advantage.
What You'll Do.
Provide oversight, guidance, and performance feedback to Third Party Administrators (TPAs) managing workers’ compensation claims programs.
Manage account-level claims performance, ensuring alignment with service standards, litigation guidelines, and regulatory requirements.
Lead onboarding and implementation processes for new TPA or MGA/TPA program partnerships.
Conduct claims due diligence during partner evaluation and program approval processes.
Monitor claim handling quality, including investigations, reserving practices, expert utilization, and legal strategy execution.
Evaluate coverage issues and risk transfer opportunities, ensuring appropriate interpretation of policy terms and exposures.
Collaborate with analytics teams to assess TPA and program performance and communicate findings to stakeholders.
Draft, review, and maintain service instructions and operational guidelines for assigned programs.
Ensure compliance with internal standards, regulatory requirements, and best practices across all TPA operations.
Escalate performance, service, or compliance issues to senior leadership when necessary.
Perform claim audits and contribute to continuous improvement of claims governance frameworks.
Communicate claim exposures clearly to both internal and external stakeholders to support informed decision-making.
Support resolution strategy development to ensure optimal financial and operational outcomes.
How You'll Work.
Team & Collaboration
Collaborate with analytics teams to assess TPA and program performance and communicate findings to stakeholders.
Communication Scope
written; verbal
Full Job Description
## Accountabilities Provide oversight, guidance, and performance feedback to Third Party Administrators (TPAs) managing workers’ compensation claims programs Manage account-level claims performance, ensuring alignment with service standards, litigation guidelines, and regulatory requirements Lead onboarding and implementation processes for new TPA or MGA/TPA program partnerships Conduct claims due diligence during partner evaluation and program approval processes Monitor claim handling quality, including investigations, reserving practices, expert utilization, and legal strategy execution Evaluate coverage issues and risk transfer opportunities, ensuring appropriate interpretation of policy terms and exposures Collaborate with analytics teams to assess TPA and program performance and communicate findings to stakeholders Draft, review, and maintain service instructions and operational guidelines for assigned programs Ensure compliance with internal standards, regulatory requirements, and best practices across all TPA operations Escalate performance, service, or compliance issues to senior leadership when necessary Perform claim audits and contribute to continuous improvement of claims governance frameworks Communicate claim exposures clearly to both internal and external stakeholders to support informed decision-making Support resolution strategy development to ensure optimal financial and operational outcomes Requirements: 7–10+ years of experience handling or litigating complex workers’ compensation claims in insurance or related environments Strong technical expertise in claims management, litigation strategy, and insurance policy interpretation Experience working with Third Party Administrators (TPAs), MGAs, or similar claims outsourcing models Strong understanding of coverage analysis, reserving practices, and risk transfer concepts Excellent negotiation skills with the ability to influence outcomes while maintaining strong professional relationships Strong comm
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