Sr. Workers Compensation Claims Management

We are currently seeking the right candidate who will bring added value to all key stakeholders by assisting and educating employers with managing their Workers’ Compensation claims. The Advocate must also engage with claims examiners to ensure best practices for the most optimal results.

Responsibilities include analyzing loss runs and claim handler status reports, then strategizing and negotiating to move cases to resolution. Documenting results, trends and outcomes is a critical component of the deliverables. Proficiency in Excel, Word, and Power Point is a requirement to create professional deliverables.

Job duties also include analysis of Experience Rating Forms, calculating X-Mod forecasts and knowledge of the basis for WCIRB recalculation opportunities.

A strong network of defense attorneys, Workers’ Comp vendors and doctors is needed to recommend and advise on managing these aspects of claims.

Duties include daily interaction with multiple employers, claim examiners and insurance brokers.

In addition, the Advocate must have strict organizational ability to set and adhere to tight diaries following up on activities that achieve the desired results. 

The job includes consistent follow up and report scheduling, leading and facilitating in-person or telephonic claims reviews for productive, informative exchange of information and ensuring accountability to agreed-upon action plans. It also requires the ability to learn many different carrier/TPA on line claim systems, in addition to our internal programs and processes.

The Advocate is responsible for interpreting and summarizing data to provide the employer with information that allows them to make the best financial, legal and ethical decisions about managing their Workers’ Compensation claims.

The ESM Claims Advocate is a consistent and persistent advocate for employers and a service partner with insurance brokers. 

Responsibilities:

This job requires professionalism and a broad technical knowledge of claims, California Labor Code, case law, California Experience Rating, insurance policy terms and employment issues.

The right candidate is adept at analysis of claims, identifying the key outstanding issues, and recommending appropriate actions to ensure timely, and cost saving resolution. We are searching for a Workers’ Compensation Claims Advocate who understands the risks that employers face and can develop relationships with all stakeholders, serving as a trusted advisor.

Analytical ability and an excellent memory for details are a requirement. Building relationships with multiple employers, brokers, and claims handlers is needed to ensure success.

The job requires dogged perseverance, flexibility, ability to think globally and recommend detailed actions. The right person is compassionate and empathetic, yet firm and confident in making recommendations to employers and claims handlers.

Excellent communication skills are imperative. These include creating presentations with Power Point and Excel, composing newsletter articles or blogs to educate employers and brokers, excellent writing ability to succinctly summarize claims action items and target dates, and verbal speaking ability via GoToMeeting webinars.

Experience:

We are conducting a search for the best candidate - one who has years of working within the Workers’ Compensation claims arena.  The ideal candidate understands the complexities of X-mods, has broker relationships, understands the role of Claims Advocate and advocacy for employers and has had claim handler experience.

Assisting an employer with managing their Workers’ Compensation risk requires basic understanding of types of policies, Captives, PEOs and Carve Outs.

ESM is a small business looking for an entrepreneurial minded individual who can think strategically and understands the technicalities of Workers’ Compensation claims management to help enhance our services and deliverables.

Requirements:

• The candidate must have 5 years of Workers’ Compensation claims advocacy experience.
• Certificates of WCCA, WCCP, ARM, Self-Insurance certificate, CPDM or other certification.
• Prior brokerage experience or carrier/ TPA claim examiner position.
• Must be a critical thinker and a problem solver.
• Excellent organizational and time management skills. Must be able to set priorities and manage their time and budgets accordingly.
• Excellent computer skills (MSFT Word, Excel, Power Point, Outlook) is a requirement.
• Must be able to clearly communicate verbally and in writing and have an ability to summarize data in a succinct manner.
• Must be able to confidently recommend, persuade, negotiate, and achieve results.
• A desire to help our company succeed by making a positive contribution to employers and the communities that we serve.
• Occasional travel to client is required
• Confidentiality is a must