TPA Claims Specialist II

USI Insurance Services; Burlington (MA); On-site; USD 57,000 - 77,000; Full time

Job summary

USI Insurance Services seeks an experienced adjuster to manage workers' compensation claims, including lost and non-lost time cases. You will apply in-depth knowledge of claims processes, communicate with clients, carriers, and claimants, and support negotiations and resolutions.

The role requires at least 5 years in claims adjusting, a strong analytical mindset, and a collaborative approach within a team environment. Licenses in applicable jurisdictions are required.

Qualifications

• Minimum 5 years of claims adjusting experience.
• College degree preferred but high school diploma or GED acceptable.
• Proficient to expert in MS Office suite.
• Must be licensed in all jurisdictions handled.
• Strong written and verbal communication skills.
• Ability to work well in a team environment.
• Strong analytical thinking and problem-solving skills.
• Strong organizational and negotiation abilities.

Responsibilities

• Adjust lost and non-lost time workers' compensation claims.
• Communicate effectively with internal and external customers.
• Apply knowledge of workers' compensation strategies and adjusting practices.
• Enter first reports of injury and adjust claims in the systems.
• Participate in claim advocacy, negotiations, and settlements.
• Review and approve loss time medical services and expenses.
• Plan and attend claim reviews with clients, carriers and auditors.
• Identify client issues and drive resolution plans.
• Analyze claims per policy and procedures.

Skills

Claims adjusting

Communication

Workers' comp knowledge

Negotiation skills

Analytical thinking

Team player

MS Office

Education

College degree preferred

Tools

MS Office

Job description

Description and Requirements

General Description

Adjuster of lost and non lost time claims for workers compensation.

Responsibilities

• Advanced Knowledge of claims function and processes.
• Ability to effectively communicate with internal and external customers.
• Strong understanding of workers compensation or disability claims management, strategies, resolution techniques and adjusting.
• Technical capability to enter first reports of injury and to adjust lost time and non lost time claims 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.
• 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.

Knowledge, Skills And Abilities

• Ideal candidate will have a minimum 5 years of claims adjusting experience.
• College degree preferred but high school diploma or graduate equivalent degree required.
• Proficient-to-expert in MS Office suite of products.
• Must be licensed in all jurisdictions handled.
• Superior written and oral communication skills.
• Ability to work well in a team environment.
• Must have strong analytical thinking and problem-solving skills.
• Strong organizational skills required.
• Strong negotiation skills required.

Why USI?

With approximately $3 billion in revenue and over 10,500 associates across approximately 200 offices nationwide, USI is one of the largest insurance brokerage and consulting firms in the world. At USI, we have created one of the most dynamic personal and professional development cultures in the industry. We invest heavily in our associates, and we take pride in celebrating their growth and success through our one-of-a-kind employee reward and recognition programs.

Unrivaled Resources and Support

What truly distinguishes USI as a premier insurance brokerage and consulting firm is the USI ONE Advantage®, a game-changing value proposition that delivers to clients a robust set of risk management and benefit solutions with bottom-line financial impact. USI ONE® represents Omni, Network, Enterprise—the three key elements that set USI apart from the competition. Through USI ONE, we develop strategic, timely, and effective risk management and benefit programs in terms that are easy to understand, and we demonstrate how the solutions can have a positive economic impact.

Industry-Leading Programs, Rewards, and Recognition

In addition to competitive pay, incentives, and benefits, USI recognizes associates through our Summit Awards program, rewarding excellence in those who build our brand each day. USI offers employee programs that recognize outstanding achievement and help our associates lead healthy, productive lives. We turn care into action with our award-winning wellness program, college scholarships for associates' children, and financial help in times of need.

Deep Community Engagement

We are committed to giving back to our local communities and supporting a culture of environmental sustainability. From sharing our time, talent, and resources to support local non-profit organizations, animal shelters, and environmental beautification and restoration projects – to partnering with eco-conscious vendors and taking steps to reduce our own environmental footprint – we’re working together as ONE to build a better future.

Committed to a Diverse and Inclusive Workplace

Our award-winning I’m With U diversity and inclusion program educates our associates to help them better understand and serve our clients, prospects, fellow team members, and local communities through curated education and training resources, employee support programs, and community outreach initiatives to build a more diverse, equitable, and inclusive culture.

Nationally Recognized as a Top Insurance Employer

• Recognized as one of Insurance Business America’s Top Insurance Employers eight consecutive years (2018-2025).
• Named to Business Insurance’s annual list of the Best Places to Work in Insurance six years in a row (2020-2025).
• Named to Fortune’s Best Workplaces in Financial Services & Insurance list for the last two years (2024-2025).
• Certified as a Great Place To Work two years in a row (2024-2025).

Visit our Awards and Accolades page for a complete list of our latest industry awards and recognitions!

USI is committed to providing a full-suite of competitive benefits for our growing population and its diverse needs. We offer a wide range of health, welfare and financial benefits including medical, wellness, dental and vision, 401(k), flexible spending and health savings accounts, short and long-term disability, life insurance and other unique employer-sponsored and voluntary programs. USI also offers a generous paid time off policy, paid family leave benefit as well as paid holiday time.

$57,000 - $77,000