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Workers' Compensation TPA Oversight Specialist at RLI | Swiftcruit
We’re not like other insurance companies. From our specialty products to our business model, our culture to our results — we’re different. Different is who we are, and how we work, interact, deliver and succeed together. Creating a different and better insurance experience doesn’t just happen. It takes focus and a shared passion for going beyond the expected to forge relationships and deliver care that makes a difference. This approach rises from and is supported by our talented, ethical and smart team of employee owners united around a single purpose: to work alongside our customers and partners when they need us, in unexpected ways, with exceptional results. Apply today to make a difference with us.
RLI is a Glassdoor Best Places to Workcompany with a strong, successful background. For decades, our financial track record has been stellar — a testament to our culture and validation of our reputation as an excellent underwriting company.
Position Purpose
This role focuses on oversight rather than direct handling of workers’ compensation (WC) claims. The WC Claim Oversight Specialist will monitor the performance and decision-making of the external third-party administrator (TPA) with particular focus on managing higher exposure WC claims. The goal is to ensure claim strategies, reserve practices, and resolution paths align with RLI’s standards, mitigate risk, and support optimal outcomes.
The Claim Oversight Specialist will not direct handle claims in this role. Instead, this role monitors and helps direct the quality and strategy of the TPA’s adjustment of WC claims.
Principal Duties & Responsibilities
Review higher exposure WC claims managed by TPA to ensure compliance with legal requirements and RLI's standards, expectations, and strategic direction.
Identify, address and escalate concerns related to reserve adequacy, litigation strategy, medical management, and settlement positioning.
Review new claims for assignment and confirmation of coverage.
Partner with TPA claim handlers and leadership to ensure WC claims are timely administered and resolved, including review and approval of reserve requests above TPA’s authority.
Coordinate and collaborate with RLI Claim operations staff on the set-up, processing, payment and resolution of WC claims.
Provide timely feedback to internal stakeholders on WC claim handling performance, opportunities for improvement, and potential risks.
Collaborate with internal claim leadership to support file audits or performance reviews of TPA.
Communicate with underwriters regarding WC claims and industry trends.
Maintain awareness of regulatory or jurisdictional requirements that may impact WC claim strategy or handling.
Support special projects related to TPA, claim quality, or claim data review as needed.
Education & Experience
Typically requires a bachelor’s degree in business administration, insurance, or a related field
Four (4) or more years of workers’ compensation claims handling experience, including experience with complex and litigated claims.
Two (2) or more years of experience providing Third-Party Administrator (TPA) oversight through an insurance carrier, self-insured retention (SIR) program, self-insured organization, or equivalent environment, including experience monitoring TPA performance, conducting claim reviews, and ensuring adherence to established claims handling standards and service expectations.
Experience evaluating claim handling, identifying areas of concern, and working with TPAs or other claims professionals to drive appropriate claim outcomes.
Prior supervisory, team lead, or claims management experience preferred.
Experience overseeing complex or high-exposure workers’ compensation claim portfolios preferred.
Knowledge, Skills, & Competencies
Ability to proactively and strategically assess WC claims and TPA’s claim management.
Demonstrated knowledge of workers’ compensation claims practices, including claim investigation, reserving, litigation management, settlement strategy, and regulatory compliance.
Strong analytical and critical thinking skills with the ability to evaluate claim handling against WC legal requirements and industry and internal standards.
Clear written and verbal communication skills for summarizing claim concerns and recommendations.
High attention to detail and a proactive approach to identifying potential issues.
Ability to work independently and manage time effectively
Familiarity with jurisdictional nuances in WC and best practices for vendor management.
Compensation Overview
The base salary range for the position is listed below. Please note that the base salary is only one component of our robust total rewards package at RLI. The salary offered will take into account a number of factors including, but not limited to, geographic location, experience, scope & responsibilities of the role, qualifications/credentials, talent availability & specialization, as well as business needs. The below range may be modified in the future.
Base Pay Range
$84,749.00 - $121,191.00
Total Rewards
At RLI, we're all owners. We hire the best and the brightest employees and allow them to share in the company's success through our Total Rewards. With the Employee Stock Ownership plan at its core, the Total Rewards program includes all compensation, benefits and perks that come with being an RLI employee.
Financial Incentives
Annual bonus plans
Employee stock ownership plan (ESOP)
401(k) — automatic 3% company contribution
Annual 401k and ESOP profit-sharing contributions (Up to 15% of eligible earnings)
Work & Life
Paid time off (PTO) and holidays
Paid volunteer time off (VTO) to support our communities
Parental and family care leave
Flexible & hybrid work arrangements
Fitness center discounts and free virtual fitness platform
Employee assistance program
Health & Wellness
Comprehensive medical, dental and vision benefits
Flexible spending and health savings accounts
2x base salary for group life and AD&D insurance
Voluntary life, critical illness, & accident insurance for purchase
Short-term and long-term disability benefits
Personal & Professional Growth
RLI encourages its employees to pursue professional development work in insurance and job-related areas. We make a commitment to employees to provide educational opportunities that help them enhance their skills and further their career advancement. RLI fosters a true learning culture and encourages professional growth through insurance courses, in-house training and other educational programs. RLI covers the cost for most programs and employees typically earn a bonus upon successful completion of approved courses and certifications. Our personal and professional growth benefits include:
Training & certification opportunities
Tuition reimbursement
Education bonuses
Diversity & Inclusion
Our goal is to attract, develop and retain the best employee talent from diverse backgrounds while promoting an environment where all viewpoints are valued and individuals feel respected, are treated fairly, and have an opportunity to excel in their chosen careers. We actively support, and participate in, initiatives led by the American Property Casualty Insurance Association that aim to increase diversity in the insurance industry. Cultivating an exceptional and diverse workforce to deliver excellent customer service reinforces our culture and is a key to achieving superior business results.
RLI is an equal opportunity employer and does not discriminate in hiring or employment on the basis of race, color, religion, national origin, citizenship, gender, marital status, sexual orientation, age, disability, veteran status, or any other characteristic protected by federal, state, or local law.
