Oversee external TPAs managing complex workers’ compensation claims. Review claim strategies, reserves, litigation, medical management, settlements, coverage, compliance, and performance against company standards. Partner with TPA handlers, internal claims teams, underwriters, and leadership to identify risks, approve reserve requests, conduct audits, improve claim outcomes, and monitor regulatory requirements. The role focuses on oversight and quality assurance rather than direct claim handling.
About Us 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 Work company 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 PurposeThis 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
Education & Experience
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.
- 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.
- 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)
- 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
- 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
- Training & certification opportunities
- Tuition reimbursement
- Education bonuses
RLI Insurance Company Chicago, Illinois, USA Office
Chicago, United States
Similar Jobs
Artificial Intelligence • Big Data • Enterprise Web • Fintech • Software • Financial Services
Leads Morningstar’s U.S. Investment Management distribution organization, setting go-to-market strategy and driving revenue, net asset flow, market-share growth, and strategic partnerships. Oversees advisor distribution, sales, national accounts, portfolio specialists, and practice consulting. Builds commercial infrastructure, manages forecasting and P&L contributions, launches investment capabilities, strengthens advisor relationships, and develops a high-performing leadership team.
Artificial Intelligence • Big Data • Enterprise Web • Fintech • Software • Financial Services
Develop qualified sales opportunities by researching prospects, following up on marketing-qualified leads, conducting outreach by phone, email, and LinkedIn, arranging meetings and demonstrations, maintaining CRM records, tracking outreach metrics, and sharing lead-quality feedback with marketing and sales teams.
Top Skills:
CRMLinkedInSales Engagement PlatformsSalesforce
Artificial Intelligence • Professional Services • Business Intelligence • Consulting • Cybersecurity • Generative AI
Leads custom application development, architecture, testing, modernization, and delivery across cloud-native and on-premise environments. Translates business requirements into scalable technical solutions, coordinates software planning and releases, reviews code, applies CI/CD and automated testing, advises clients on technology decisions, coaches engineers, and advances AI-enabled engineering practices.
Top Skills:
.NetAPIsAutomated TestingCi/CdCloud-Native TechnologiesJavaMicroservicesPythonReact Native
What you need to know about the Chicago Tech Scene
With vibrant neighborhoods, great food and more affordable housing than either coast, Chicago might be the most liveable major tech hub. It is the birthplace of modern commodities and futures trading, a national hub for logistics and commerce, and home to the American Medical Association and the American Bar Association. This diverse blend of industry influences has helped Chicago emerge as a major player in verticals like fintech, biotechnology, legal tech, e-commerce and logistics technology. It’s also a major hiring center for tech companies on both coasts.
Key Facts About Chicago Tech
- Number of Tech Workers: 245,800; 5.2% of overall workforce (2024 CompTIA survey)
- Major Tech Employers: McDonald’s, John Deere, Boeing, Morningstar
- Key Industries: Artificial intelligence, biotechnology, fintech, software, logistics technology
- Funding Landscape: $2.5 billion in venture capital funding in 2024 (Pitchbook)
- Notable Investors: Pritzker Group Venture Capital, Arch Venture Partners, MATH Venture Partners, Jump Capital, Hyde Park Venture Partners
- Research Centers and Universities: Northwestern University, University of Chicago, University of Illinois Urbana-Champaign, Illinois Institute of Technology, Argonne National Laboratory, Fermi National Accelerator Laboratory
