Risk Management Analyst – Workers’ Compensation

CVS Health

Remote Analyst overseeing workers’ compensation claims program for CVS Health. Managing TPA performance and ensuring compliance with claim handling guidelines.

Posted 5/6/2026full-timeRemote • Rhode Island • 🇺🇸 United StatesMid-LevelSenior💰 $43,888 - $102,081 per yearWebsite

About the role

Key responsibilities & impact

Proactively oversee and manage TPA performance through reporting, auditing, and claim reviews.
Oversee the daily work product of multiple lost time and medical-only workers’ compensation adjusters in your assigned territory, completing monthly audits and case reviews.
Actively participate in internal claim reviews and legal roundtables.
Ensure that reserves and settlement authorities are reviewed and granted in compliance with our internal processes.
Review and interpret medical reports, expert reports, legal and various supporting claim documents.
Analyze case and internal investigative materials to determine legal liability and that reserves are set for the known exposure.

Requirements

What you’ll need

1-3 years’ experience handling Lost Time workers’ compensation claims and/or equivalent experience with TPA oversight.
Experience in Microsoft Office applications with a proven ability to learn new software programs and systems as required.
Insurance designations is a plus.
California workers’ compensation claims handling experience or jurisdictional knowledge a plus.
Ability to interact and navigate situations with both internal and external partners.
Ability to work independently and in an environment requiring teamwork and collaboration.
Ability to train less experienced TPA adjusters on implementation of claim best practices.
Demonstrate excellent analytical, organizational, written, and communication skills, with the ability to generate concise claim outlines that capture and detail critical case components.
Exhibit proven time management skills and the ability to oversee a high volume of cases effectively.

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
comprehensive benefits package

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

workers' compensation claimsTPA oversightauditingcase reviewsmedical report interpretationlegal document analysisanalytical skillstime management

Soft Skills

communication skillsorganizational skillsteamworkcollaborationtrainingindependenceinterpersonal skills

Certifications

insurance designations