USI Insurance Services · 15 hours ago
TPA Claims Specialist III
Woburn, MA
Full-time
Onsite
Senior Level, Lead/Staff
$74K/yr - $97K/yr
10+ years expUSI Insurance Services is one of the largest insurance brokerage and consulting firms in the world, and they are seeking a Senior Level lost time claim adjuster for workers compensation. The role involves managing claims processes, communicating with customers, and negotiating settlements while ensuring compliance with workers compensation jurisdiction.
Commercial InsuranceConsultingEmployee BenefitsFinancial ServicesHealth InsuranceInsuranceRisk Management
Responsibilities
Advanced Knowledge of claims function and processes
Ability to effectively communicate with internal and external customers
Expert understanding of workers compensation or disability claims management, strategies, resolution techniques and adjusting
Technical/administrative capability to adjust lost time, utilizing the features of the TPA claim management systems
Participates in claim advocacy and negotiations, including claim denials, reserving files, and claim reporting, issuing payments, attending hearings, conciliations or mediations and filing of state forms
Determine compensability of the claim as it relates to the worker compensation jurisdiction
Review and approval of loss time, medical services and expenses to be paid of the claims file
Plan and attend claim reviews with clients, carriers and auditors
Negotiate and recommend claim file settlements to the client
Ability to identify client issues, build a plan towards resolution, execute and manage internal and external expectations effectively
Analyzes claims based on the TPA best practices as outlined in the 'Policy and Procedures' manual
Skill set to implement new business with 'Special Account Instructions'
Understand the financial impact of losses
Ability to communicate with internal resources to explain results and help develop improvement for risk management plans
Ability to develop high quality output documents for internal resources, clients and carriers
Understand client business issues
Attend sales presentations
Act as a team leader with the non lost time claim adjuster and the medical case manager
Qualification
Required
Advanced Knowledge of claims function and processes
Ability to effectively communicate with internal and external customers
Expert understanding of workers compensation or disability claims management, strategies, resolution techniques and adjusting
Technical/administrative capability to adjust lost time, utilizing the features of the TPA claim management systems
Participates in claim advocacy and negotiations, including claim denials, reserving files, and claim reporting, issuing payments, attending hearings, conciliations or mediations and filing of state forms
Determine compensability of the claim as it relates to the worker compensation jurisdiction
Review and approval of loss time, medical services and expenses to be paid of the claims file
Plan and attend claim reviews with clients, carriers and auditors
Negotiate and recommend claim file settlements to the client
Ability to identify client issues, build a plan towards resolution, execute and manage internal and external expectations effectively
Analyzes claims based on the TPA best practices as outlined in the 'Policy and Procedures' manual
Skill set to implement new business with 'Special Account Instructions'
Understand the financial impact of losses
Ability to communicate with internal resources to explain results and help develop improvement for risk management plans
Ability to develop high quality output documents for internal resources, clients and carriers
Understand client business issues
Attend sales presentations
Act as a team leader with the non lost time claim adjuster and the medical case manager
Ideal candidate will have a minimum of 10 - 15 years of claims administration experience
High school diploma or graduate equivalent degree required
Expert in MS Office suite of products, especially MS Excel
Superior written and oral communication skills
Ability to lead a team and work well in a team environment
Must have expert analytical thinking and problem-solving skills
Superior organizational skills required
Expert negotiation skills required
Preferred
College degree preferred
Benefits
Medical
Wellness
Dental
Vision
401(k)
Flexible spending and health savings accounts
Short and long-term disability
Life insurance
Paid time off policy
Paid family leave benefit
Paid holiday time
Company
USI Insurance Services
USI Insurance Services is an insurance brokerage and consulting firm that delivers diversified insurance and financial services.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$1BKey Investors
Kohlberg Kravis Roberts
2023-09-11Private Equity· $1B
2017-03-17Secondary Market
2017-03-17Acquired
Leadership Team
Stew Gibson
Senior Vice President and Chief Information Officer
Dave Petno
Vice President, Employee Benefits Consultant
Recent News
USI Insurance Services
2025-10-25
2025-10-21
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