TPA Claims Specialist II (Workers' Compensation)

Location: Braintree, Burlington, or Needham, Massachusetts; Bedford, New Hampshire; or Warwick, Rhode Island

Salary: $57,000–$77,000 per year

Company

hirify.global is a large insurance brokerage and consulting firm providing risk management and employee benefit solutions through a nationwide network.

What you will do

• Adjust lost-time and non-lost-time workers' compensation claims.
• Determine claim compensability according to the applicable workers' compensation jurisdiction.
• Manage claim denials, reserves, payments, medical services, expenses, reporting, and state filings.
• Participate in claim advocacy, negotiations, hearings, conciliations, and mediations.
• Plan and attend claim reviews with clients, carriers, and auditors.
• Identify client issues, develop resolution plans, and manage internal and external expectations.

Requirements

• Rhode Island workers' compensation claims experience is required; experience in Massachusetts, Vermont, and other handled jurisdictions is also needed.
• At least five years of claims adjusting experience.
• Licensure in all jurisdictions handled is required.
• Advanced knowledge of claims functions, processes, workers' compensation or disability claims management, and adjusting.
• High school diploma or graduate equivalent degree required; college degree preferred.
• Expertise in Microsoft Office, strong communication, analytical, organizational, problem-solving, teamwork, and negotiation skills.

Culture & Benefits

• Medical, dental, vision, wellness, life insurance, and disability benefits.
• 401(k), flexible spending accounts, health savings accounts, and other financial benefits.
• Paid time off, paid family leave, and paid holidays.
• Employee recognition, wellness, scholarship, and financial assistance programs.
• Diversity, inclusion, community engagement, and sustainability initiatives.