Sr. Workers Compensation Claims Management

Responsibilities

• Assist and educate employers with managing their Workers’ Compensation claims.
• Engage with claims examiners to ensure best practices for optimal results.
• Analyze loss runs and claim handler status reports, strategize, and negotiate to move cases to resolution.
• Document results, trends, and outcomes.
• Analyze Experience Rating Forms, calculate X-Mod forecasts, and understand the basis for WCIRB recalculation opportunities.
• Recommend and advise on managing claims using a strong network of defense attorneys, Workers’ Comp vendors, and doctors.
• Interact daily with multiple employers, claims examiners, and insurance brokers.
• Maintain strict organizational ability to set and adhere to tight diaries, following up on activities that achieve desired results.
• Conduct consistent follow-up and report scheduling.
• Lead and facilitate in-person or telephonic claims reviews for productive, informative exchange of information.
• Ensure accountability to agreed-upon action plans.
• Learn and utilize various carrier/TPA online claim systems, in addition to internal programs and processes.
• Interpret and summarize data to provide employers with information for the best financial, legal, and ethical decisions regarding Workers’ Compensation claims management.
• Act as a consistent and persistent advocate for employers and a service partner with insurance brokers.
• Demonstrate professionalism and broad technical knowledge of claims, California Labor Code, case law, California Experience Rating, insurance policy terms, and employment issues.
• Analyze claims, identify key outstanding issues, and recommend appropriate actions for timely, cost-saving resolution.
• Understand employer risks and develop relationships with all stakeholders, serving as a trusted advisor.
• Exhibit analytical ability and an excellent memory for details.
• Build relationships with multiple employers, brokers, and claims handlers.
• Demonstrate dogged perseverance, flexibility, ability to think globally, and recommend detailed actions.
• Be compassionate and empathetic, yet firm and confident in making recommendations.
• Utilize excellent communication skills, including creating presentations with PowerPoint and Excel, composing newsletter articles or blogs, summarizing claims action items and target dates, and verbal speaking ability via webinars.

Experience

• Years of working within the Workers’ Compensation claims arena.
• Understanding of X-mods, broker relationships, the role of a Claims Advocate, and advocacy for employers.
• Prior claim handler experience.
• Basic understanding of types of policies, Captives, PEOs, and Carve Outs.
• Entrepreneurial mindset with the ability to think strategically and understand the technicalities of Workers’ Compensation claims management.

Requirements

• 5+ years of Workers’ Compensation claims advocacy experience.
• Certificates of WCCA, WCCP, ARM, Self-Insurance certificate, CPDM, or other relevant certification.
• Prior brokerage experience or carrier/TPA claim examiner position.
• Critical thinker and problem solver.
• Excellent organizational and time management skills, with the ability to set priorities and manage time and budgets accordingly.
• Excellent computer skills (MSFT Word, Excel, Power Point, Outlook).
• Ability to communicate clearly verbally and in writing, and summarize data succinctly.
• Ability to confidently recommend, persuade, negotiate, and achieve results.
• Desire to help the company succeed by making a positive contribution to employers and communities.
• Occasional travel to clients is required.
• Confidentiality is a must.

Category
Sales & Business Development