Workers' Compensation Claim Monitoring Specialist at RLI in Chicago, IL

Job description

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 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 6+ years of related experience handling WC claims, with exposure to complex and litigated files. Supervisory experience in a WC environment is strongly preferred. [OR] equivalent level of education and experience Experience with vendor-managed claims or quality assurance oversight is a strong plus. Knowledge, Skills, & Competencies Ability to proactively and strategically assess WC claims and TPA’s claim management. 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 in a flexible, part-time arrangement. 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