Claims Advocate - Workers' Compensation
Company: SFM Companies (SFM Mutual Insurance)
Location: Milwaukee
Posted on: November 2, 2024
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Job Description:
Join the top Workers Compensation insurance provider and
experience an environment where you'll enjoy great work/life
balance and the satisfaction of helping others. This position is on
our Third Party Administrator team and candidates with MN claims
handling experience are preferred. Working as a Claims Advocate,
you will handle lost time claims and complex medical claims; you
will work with a variety of people to bring claims to successful
resolutions while providing excellent customer service.
This position is remote, and persons can live ONLY in MN, WI, IA,
KS or MO. Some travel to Corporate HQs in MN is required and
attending meetings at Corporate Headquarters may also be
required..
Your job title will be based on the experience you offer, but a
minimum of 6 months WC lost time claims experience is needed.
As Workers' Compensation Claims Advocate, you will Investigate and
manage claims in accordance with state workers' compensation
statutes, case law, and Company best practices. You will calculate
lost wages and manage more complex medical claims and assist the
injured worker and employer in the claim process. This is a
customer focused position and claims are handled so that a
successful resolution is achieved. Working collaboratively with
self insured clients who are located in Minnesota is key to being
successful in this role. Minnesota claims handling is highly
desired. This position will be working with self insured clients,
so you will act as a third party administrator.
Our benefits include:
Affordable Medical, Dental, Vision Insurance, HSA, FSA
Flexible hybrid work environment
Traditional and Roth 401(k) plans with company match
Company contributions to help pay off student loans
Monthly home internet allowance
Free life insurance, STD & LTD
Opportunities for annual gainshare bonus
Pet insurance
Generous PTO
9 paid holidays
Paid parental leave
Annual company-wide volunteer day
Discounts on gym memberships, fitness apps and weight loss
programs
Adoption financial assistance
Responsibilities:
Makes timely contact with all parties to a claim to gather
necessary information to determine liability and fulfill
regulatory, contractual, and internal reporting requirements.
Applies the workers' compensation statute and case law to facts to
determine compensability. Uses internal resources as required by
company best practices or client servicing instructions for
questionable compensability decisions and subrogation or fraud
issues.
Sets expectations with the injured worker and employer of wellness,
stay-at-work, or return-to-work, and importance of ongoing
communication between all parties. Involve strategic business
partners, to assist with return-to-work or stay-at-work.
Authorizes payment of medical and wage loss benefits within payment
authority.
Assigns, directs, and manages medical, rehabilitation and legal
services pursuant to the respective business's procedures, client
service instruction and applicant state law. This includes
documentation in claim comments of facts, issues and plans.
If needed, attends field visits of policyholders, agents and
injured workers, with assistance as needed. May include travel.
Establishes initial and ongoing case reserves within authority
level that accurately reflect file exposure in accordance with
Company best practices and client reserving guidelines relating to
qualitative analysis and timing. Recommends reserves for cases that
exceed authority level.
Communicates and educates the employer on case exposure/reserves
and how to mitigate the exposure. Communicates and partners with
the reinsurer regarding case exposure/reserves, high expense items
and issues which impact future costs.
Provides and documents strategy to bring cases to resolution per
SFM best practices, procedures and philosophy. This is evidenced by
documenting files in claim comments with 1) timely action plans; 2)
pertinent facts and issues for roundtable discussions; and 3)
analysis of settlement exposure, including, with assistance, the
use of spreadsheets.
Qualifications:
Bachelor's degree preferred.
Six months or more of workers compensation lost time experience
Knowledgeable of state applicable Workers' Compensation Act and its
application to claims administration.
Knowledge and skills in state regulatory reporting.
Strong knowledge of medical terminology, anatomy and
procedures.
Understanding of insurance finance.
Excellent customer service and interpersonal skills.
Good oral and written communication skills.
Ability to effectively interact with a diverse group of customers
and business units.
Ability to assimilate, understand and analyze information from a
variety of sources.
Strong math skills.
Developing skills in investigating, negotiating and settling
claims.
Problem-solving and decision-making skills.
Acts as a mentor to others when requested.
Strong computer skills (preferably in a Windows environment.)
Effective prioritization, organization and time management
skills.
Demonstrates positive teaming skills focused on team results.
Physical Requirements:
Regular attendance is required. Work takes place in a semi
paperless environment within an office setting, either on business
premises or remote location, using standard office equipment such
as computers, phones, and photocopiers, which requires being
stationary for extended periods of time. While performing the
duties of this job, the employee is regularly required to talk or
hear, and maintain concentration and focus. The employee frequently
is required to stand; walk; use hands and fingers, handle or feel;
and reach with hands and arms and work with close vision. This
position requires the ability to occasionally lift office products
and supplies, up to 20 pounds. Work is performed indoors with
little to no exposure to extreme outdoor weather conditions.
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.
About SFM
SFM is unique in that we are small enough that your voice is heard
but has all the benefits and perks of a larger employer. We value
your opinion, help you reach your goals, and make it easy for you
to maintain work-life balance. SFM is committed to creating the
best work environment and believes that our exceptional and
motivated employees are our greatest strength.
Join us!! Click "Apply" Now
_________________________________________________________________
SFM Mutual Insurance Company and each of its parent companies,
subsidiaries and/or affiliated companies are Equal
Opportunity/Affirmative Action Employers. SFM provides equal
employment opportunities to all employees and applicants for
employment and prohibits discrimination and harassment of any type
without regard to race, color, religion, age, sex, national origin,
disability status, genetics, protected veteran status, status with
regard to public assistance, sexual orientation, gender identity or
expression, or any other characteristic protected by federal, state
or local laws.
SFM Companies, EEO/AA Employers. SFM is a participant of E-Verify.
Applicants have rights under Federal Employment Laws.
Keywords: SFM Companies (SFM Mutual Insurance), Fond du Lac , Claims Advocate - Workers' Compensation, Other , Milwaukee, Wisconsin
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