Workers' Compensation Claims & TPA Manager Cedar Insurance Company Trenton, NJ Job Details Full-time $130,000 - $175,000 a year 21 hours ago Benefits Health savings account Health insurance 401(k) Paid time off Work from home 401(k) matching Flexible schedule Qualifications Workers' compensation insurance knowledge Workers' compensation Litigation response management Full Job Description About the Position Cedar Insurance Company is seeking an experienced workers' compensation claims professional to oversee our third-party claims administrator and serve as a hands-on claims and risk-management resource for our insureds. This is not a traditional desk-adjusting position. The Workers' Compensation Claims & TPA Manager will oversee TPA performance, become directly involved in large and complex claims, monitor reserves and claim strategy, control claim costs, and help ensure claims move toward appropriate resolution. The position will work directly with adjusters, defense counsel, insureds, risk managers, brokers, and agents. We are looking for someone who can independently assess a claim, challenge strategy or reserves when appropriate, and drive action rather than simply relying on the TPA's recommendations. Key Responsibilities TPA and Claims Oversight Serve as Cedar's primary operational contact with its workers' compensation TPA. Establish and monitor claim-handling standards, authority levels, reporting requirements, and escalation procedures. Conduct regular operational and stewardship reviews with the TPA. Monitor adjuster staffing, experience, workloads, turnover, and file assignments. Hold adjusters and supervisors accountable for timely investigations, communication, reserving, and claim strategy. Perform or coordinate TPA audits and require corrective action when performance falls below Cedar's standards. Large and Complex Claims Identify claims requiring direct Cedar involvement, with a focus on significant, complex, litigated, and high-exposure claims. Review compensability, investigations, medical treatment, disability status, reserves, and return-to-work barriers. Challenge reserves and claim strategies when they are not supported by the current exposure. Participate in settlement authority decisions. Work directly with adjusters and defense counsel on litigation strategy and settlement opportunities. Present significant claim developments and recommendations to senior management. Claim Cost Management Monitor medical, indemnity, litigation, and other claim costs. Evaluate the appropriate use of nurse case management, IMEs, utilization review, pharmacy, bill review, and other cost-containment services. Promote timely settlement and claim closure where appropriate. Identify subrogation, recovery, and second-injury fund opportunities. Monitor claim costs and expense allocation on large-deductible accounts. Insured and Risk-Management Engagement Serve as a claims and risk-management contact for Cedar's insureds, risk managers, brokers, and agents. Participate in new-client on-boarding and establish claims-management and return-to-work expectations. Lead periodic claims reviews involving the insured, TPA, broker or agent, and Cedar. Help insureds implement effective return-to-work and transitional-duty practices. Work with adjusters and insureds to identify and remove barriers that unnecessarily extend disability. Address escalated service issues and reinforce claim reporting and investigation requirements. Reporting and Analysis Monitor open claim inventory, claim development, incurred and paid costs, litigation, closure rates, reporting lag, reserve changes, large losses, claim expenses, return-to-work outcomes, adjuster performance, and TPA compliance. Identify adverse trends by insured, class of business, jurisdiction, adjuster, broker, and cause of loss. Provide senior management with clear assessments of emerging claims issues and recommended actions. Provide claims insight to underwriting, actuarial, finance, and loss control. Qualifications 10+ years of workers' compensation claims experience. Experience as a claims manager, TPA manager, senior claims professional, and risk manager. Current or recent experience overseeing adjusters, a TPA, or a multi-state workers' compensation claims operation. Strong knowledge of reserving, litigation management, settlement strategy, compensability, and medical management. Experience reviewing individual claim files and directing strategy on large or complex claims. Working knowledge of return-to-work and transitional-duty practices. Experience with TPA audits, service standards, authority structures, and performance management. Familiarity with bill review and workers' compensation cost-containment programs. Multi-state workers' compensation experience. Carrier, TPA leadership, large self-insured employer, or large-deductible employer experience preferred. Healthcare, senior living, or long-term-care workers' compensation experience is a plus. About Cedar Insurance Cedar Insurance Company is a workers' compensation insurance carrier focused on serving healthcare employers. We are a growing organization that combines underwriting, claims management, loss control, and risk-management services to help our insureds manage workers' compensation exposure. This position will have direct interaction with Cedar's senior management and an opportunity to help shape our claims-management approach as the company grows.

Pay:

$130,000.00 - $175,000.00 per year

Benefits:

401(k) 401(k) matching Flexible schedule Health insurance Health savings account Paid time off Work from home Application Question(s): Have you directly managed or overseen workers' compensation adjusters or a TPA handling workers' compensation claims on behalf of an insurance carrier? Have you worked for a workers' compensation insurance carrier in a claims handling, claims management, or claims oversight role?

Experience:

Workers' compensation: 10 years (Required)

Work Location:

Hybrid remote in Trenton, NJ 08610