Workers' Compensation Claims Advocate
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Consistently establishes and maintains high levels of trust and confidence with clients, through constant contacts, prompt response and resolving client's questions and claim issues;
- Act as a liaison between clients, claims adjusters, defense attorneys, medical providers and related vendors
- Perform reserve evaluation to determine adequacy
- Provide training and claims consulting to clients and internal staff
- Assist clients with claims trending, loss stratification, and loss accrual reports
- Develop claims reporting and communication guidelines for clients
- Inform and educate clients/internal staff about regulatory updates and compliance issues
- Perform litigation management assessments
- Responsible for timely and accurate claim reports
- Coordinate claim review meetings with clients, carriers and Third Party Administrators (TPA)
- Perform workers' compensation claim audits
- Assist internal staff and clients with carrier or TPA selection
- Assist clients with the development of Return-to-Work programs
- Perform unit statistical claim evaluations
- Develop experience modification projections for clients and internal staff
- Request claims status reports and loss reports from carriers/TPAs
- Assist clients with medical provide network selection
- Aggressively manage all aspects of the workers' compensation claims management process
- Assist clients with loss prevention efforts
- Must be able to pull claim reports and loss data from carrier/TPA technology systems
- Respond timely to internal staff regarding claim questions and requests
- In conjunction with the Sales Team, determine strategy which includes claims management services
- Prepare claims reports for renewal & new business marketing efforts
- Provide technical claims support in the sales process
- Personal and Organizational Development
- Set priorities and manage workflow for self to ensure efficient, timely, and accurate processing of all responsibilities;
- Maintain cordial and effective relations with clients, co-workers, carriers, vendors, and other business contacts;
- Maintain up-to-date client claim files, workflow logs, manuals or other required documentation and records;
- Interact with others effectively utilizing good communication skills, cooperating purposefully, and providing information and guidance as needed to achieve the business goals of the Company;
- Stay informed regards to workers' compensation laws, legislative updates, carrier' claims product/program developments, technology to continuously improve knowledge and performance.
- Extensive multi-state workers' compensation claims consulting, litigation management and medical terminology
- Advanced knowledge of navigating the Internet as well as various Microsoft Office programs to include Windows, Outlook, Word, PowerPoint & Excel;
- Strong attention to detail and time management abilities;
- Strong ability to multi-task and assign priority;
- Ability to work effectively and efficiently both with and without direct supervision;
- Ability to work effectively and efficiently in a team environment as well as independently;
- Strong interpersonal communication ability
- Effective written and oral communication skills
EDUCATION and/or EXPERIENCE:
- College Degree. Insurance related experience; or equivalent combination of education and experience.
- Must have working knowledge of a variety of Microsoft Office computer software applications in word, excel, and PowerPoint, software.
- Must be able to work in a fast-paced environment with demonstrated ability to juggle multiple competing tasks and demands.
- Must have high level of interpersonal skills to handle sensitive and confidential situations. Position continually requires teamwork, demonstrated poise, tact, and diplomacy.
- CERTIFICATES, LICENSES, REGISTRATIONS:
- California Property & Casualty License or Claims Certification
- The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to stand; walk; sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. Specific vision abilities required by this job include close vision, color vision, and ability to adjust focus.
WORK ENVIRONMENT and ENVIRONMENTAL CONDITIONS:
- The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- The noise level in the work environment is usually moderate. There is no or very limited exposure to physical risk
WHY JOIN US?
15th Largest Broker in US
Voted " Best Place to Work" in the Insurance Industry
Awesome Benefits: 401K matching, Generous Time Off Policy, Flexible Work Options, Medical, Dental, Vision, Pet Insurance, Cancer Insurance, Wellness Programs, Employee Award Programs (Trips!).
EPIC embraces diversity in all its various forms—whether it be diversity of thought, background, race, religion, gender, skills or experience. We are committed to fostering a work community where every colleague feels welcomed, valued, respected and heard. It is our belief that diversity drives innovation and that creating an environment where every employee feels included and empowered, helps us to deliver the best outcome to our clients. An Equal Opportunity/Affirmative Action Employer.
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