Workers Compensation Claims Management Advocate

About ESM INSITE

ESM is a tech-enabled Risk Management firm dedicated to making a difference in the U.S. Workers’ Compensation, Safety & Compliance Industry. Our services include Workers’ Compensation Claims Management, Safety Management/Compliance, and a suite of proprietary technology solutions, including a digital inspection application, Learning Management System (LMS), analytics dashboards and a comprehensive subscription-based compliance library, all of which provide Business Intelligence to U.S. employers.

This is an opportunity to join a technology company that is in growth mode. Please visit our website for more information www.esminsite.com

Job Description
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 via Salesforce. Familiarity and experience utilizing technology is required.

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 online claim systems, in addition to our internal programs and processes using Teams
and Salesforce.

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, Labor Code, case law, California Experience Rating (NCCI a plus), insurance policy terms and employment issues. Utilizing technology to document and establish diaries is a requirement.

The right candidate is adept at analysis of claims, identifying the key outstanding issues, and recommending and negotiating 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.

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. Communication includes skill in utilizing Teams or Zoom, or other technology platforms, including Salesforce.

Requirements:

The candidate must have 3+ years of Workers’ Compensation claims advocacy experience.

Certificates of WCCA, WCCP, ARM, Self-Insurance certificate, CPDM or other certification.

Prior carrier/TPA claim examiner position.

Knowledge of public school districts is key to this open 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 analytical ability and review of complex claims is required.

Excellent computer skills (MSFT Word, Excel, Power Point, Outlook, Teams) 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.

ESM employees currently work from home.

Schedule, Hours & Location:

Monday – Friday

9/80 work schedule (every other Friday off)

California based

Compensation

Competitive salary

Comprehensive Benefits

401K Match

Stock Options

Work From Home

No recruiters please