Workers' Compensation Specialist

Job Description Job Description Our client, a leader in the maritime and shipping industry, has recently engaged a TPA to manage the day-to-day administration of workers’ compensation claims. We are seeking a skilled Worker’s Compensation Specialist to join their team on a 4-9 month contract basis, 100% onsite in Oakland. Knowledge of workers’ compensation remains essential, but focus will shift to oversight, governance, and strategic support. This role will provide support to the Third-Party Administrator as listed below: Monitoring TPA performance and compliance Reporting on claim metrics, costs, and trends Analyzing data for insights and cost containment Collaborating with TPA teams to resolve complex cases Advising internal stakeholders based on TPA outcomes RESPONSIBILITIES: Monitor TPA-managed claim files for accuracy, timeliness, and compliance with policies and regulations. Produce regular reports on claim volumes, costs, open files, and severity trends. Analyze data to identify patterns or areas for process improvement. Serve as liaison between TPA, internal staff, vocational rehab counselors, and injured workers. Manage timelines for medical evaluations and return-to-work outcomes. Ensure timely issuance of temporary and permanent disability payments. Flag and escalate complex or litigated cases to internal counsel or TPA legal team. Educate internal staff on claims procedures, utilizing TPA-generated materials. Coordinate with TPA to ensure correct distribution of notices and regulatory filings. Validate TPA compliance with state-mandated reporting requirements and ADA guidelines. Be the main point of contact for TPA audits and performance reviews. Assist with contract renewals or SLA negotiations relating to TPA services. QUALIFICATIONS: Bachelor’s degree preferred, work experience considered. 3 years of hands‐on experience in workers’ compensation or claim administration. Experience working as a claims examiner, supervisor, or worked on the broker side Understanding of California statutes, Labor Code, and WC regulatory environment. Proficiency in claims metrics, KPIs, and TPA-style reporting. Familiarity with ADA, vocational rehab protocols, medical/legal terminology. Excellent stakeholder communication—written, verbal, and presentation. Ability to manage competing priorities, analyze complex situations, recommend corrective action. Prior exposure to TPA workflows, service-level agreements (SLAs), and handling escalations is a plus. Skills in contract oversight and SLA performance evaluation is a plus. Organized, detail-oriented, with strong judgment and adaptability. Collaborative approach—able to work cross-functionally with internal teams and external vendors. Why this role matters: TPAs play a specialized role in claims administration—processing, adjudicating, and ensuring compliance with rules and regulations. Your role empowers the organization by overseeing that work, validating outputs, and delivering strategic insights that drive improved claim outcomes and cost savings. PHYSICAL REQUIREMENTS: May be tasked with lifting, carrying, pushing or pulling up to 25 lbs., if able to do so. Must be able to sit for prolonged periods of time and walk/stand for moderate periods of time. Must be able to bend at the knees and waist frequently Must be able to repetitively use a telephone and a computer mouse and keyboard. All employment is contingent on candidates providing at least two positive professional references from prior managers. We are looking for local candidates only. U.S. Citizens and those authorized to work in the U.S. are encouraged to apply. We are unable to sponsor at this time. To apply for this position please visit our website at www.PsiNapse.com, and click on “Looking for Work”. Thank you for your interest. Please understand that only qualified candidates will receive a response. PsiNapse Technology, a national, workforce augmentation and solutions firm, offers competitive compensation, professional service, and customized benefits to qualified temporary and career professionals looking for employment. We are an Equal Opportunity Employer and do not discriminate on the basis of race, religion, color, gender, sexual-orientation, age, national origin, citizenship, disability, or any other protected category.

Location: Oakland, California, US

Posted Date: 7/27/2025