Program Claim Manager, Workers Compensation in United States at Jobgether

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Program Claim Manager, Workers Compensation based in United States.

This role sits at the intersection of claims governance, program oversight, and strategic risk management within a fast-growing commercial insurance environment.
You will be responsible for overseeing Third Party Administrators (TPAs) handling complex workers’ compensation claims, ensuring accuracy, compliance, and performance alignment with program standards.
The position requires a strong balance of technical claims expertise, litigation awareness, and strategic decision-making to drive optimal claim outcomes.
You will play a key role in evaluating coverage, reserving practices, and risk transfer opportunities while ensuring high-quality investigations and legal strategies are in place.
The environment is dynamic and highly collaborative, involving close coordination with internal teams, external partners, and regulatory stakeholders.
You will also contribute to program implementation, performance analysis, and continuous improvement of claims operations.
This role is ideal for a seasoned claims professional who thrives in complex, high-exposure environments and enjoys influencing outcomes at a strategic level.

• 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 communication skills, both written and verbal, with the ability to engage internal and external stakeholders effectively
• Ability to manage multiple complex claims and adapt to shifting priorities in a fast-paced environment
• Proficiency in digital or paperless claims management systems and related tools
• Strong analytical thinking and ability to evaluate claim exposures and financial implications
• 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

Benefits:

• Competitive annual salary ranging from $87,600 to $120,000 depending on experience and qualifications
• Comprehensive medical, dental, and vision insurance plans
• Life insurance coverage including eligible dependents
• Health care and dependent care flexible spending accounts
• 401(k) retirement savings plan
• Paid time off and holiday benefits
• Opportunities for professional development and career advancement
• Exposure to complex, high-impact claims programs in a national insurance environment
• Collaborative and inclusive work culture focused on continuous improvement and diversity