The Jacobson Group · 2 days ago
Claims Management Specialist (TPA Oversight)
United States
Contract
Remote
Mid, Senior Level
$30/hr - $50/hrThe Jacobson Group is a consulting firm seeking an experienced Claims Management professional for a temporary role. The position focuses on oversight of third party administrator claims processes, ensuring compliance and quality while managing various claims-related responsibilities.
AssociationFinancial ServicesInformation Technology
Hiring Manager
Morgan Falck
Responsibilities
Provide oversight of the TPA’s claim examination process to ensure accuracy, compliance, and timely resolution
Review and approve claim payments within delegated authority limits
Conduct claim revisions and ensure appropriate documentation and rationale for adjustments
Issue or validate claim denials, ensuring decisions are well supported and aligned with policy provisions
Manage and resolve beneficiary disputes, including coordination with internal stakeholders and external partners
Evaluate and oversee complex and contestable claims, ensuring thorough investigation and fair outcomes
Identify potential risk exposures and contribute to broader risk management strategies
Maintain strong working relationships with the TPA, internal teams, and other relevant partners
Monitor claim trends, escalate concerns, and recommend process improvement
Qualification
Required
Proven experience in life insurance, claims management
Background handling contestable, complex, or sensitive claims
Strong understanding of claims regulations, policy interpretation, and industry best practices
Experience working with or overseeing third party administrators (TPAs)
Excellent analytical, communication, and decision making skills
Demonstrated ability to operate in an oversight focused role rather than hands on claims administration
Benefits
Medical insurance
Dental insurance
Vision insurance
401(k) retirement savings plan
Company
The Jacobson Group
The Jacobson Group is the leading provider of talent to the insurance industry.
Founded in 1971
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Corey Pinkham
Chief Executive Officer
Recent News
2026-01-06
2025-08-20
2025-03-04
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