Senior Claims Advocate- Workers Compensation

Job Overview:

We are seeking an experienced Senior Workers’ Compensation Claims Advocate to manage a team while providing expert claims advocacy, strategic guidance, and proactive claims management for our clients. The ideal candidate will have extensive experience in workers’ compensation claims handling, a deep understanding of jurisdictional regulations, and strong leadership skills to mentor and develop team members. This is a hybrid role, requiring at least three days per week in the office if possible.

Key Responsibilities:

Claims Advocacy & Management

• Serve as a dedicated advocate for clients, managing complex workers’ compensation claims from inception to resolution.
• Provide strategic oversight, ensuring claims are handled efficiently and cost-effectively by carriers, TPAs, and legal partners.
• Identify claim trends and develop tailored solutions to minimize client exposure and improve claim outcomes.
• Negotiate settlements, challenge claim denials, and advocate for fair claim handling.

Team Leadership & Development

• Oversee team workflows to ensure timely and efficient claims handling and client service.
• Conduct regular team meetings and training sessions to enhance technical knowledge, compliance awareness, and professional development.
• Establish and track key performance indicators (KPIs) for the team to ensure high-quality claims advocacy and adherence to best practices.

Client Support & Risk Mitigation

• Advise clients on best practices for injury management, return-to-work programs, and compliance with state and federal workers’ compensation regulations.
• Conduct claim reviews, prepare detailed reports, and offer recommendations to reduce loss experience.
• Collaborate with clients’ HR, risk management, and safety teams to implement proactive claim prevention strategies.

Carrier & TPA Liaison

• Work closely with insurance carriers, third-party administrators, and defense attorneys to ensure timely and effective claim resolutions.
• Advocate for clients in disputes, ensuring claim reserves are appropriate and settlements are fair.

Regulatory & Compliance Expertise

• Stay up to date on workers’ compensation laws and industry changes across multiple jurisdictions.
• Ensure clients remain compliant with all reporting, safety, and claims handling requirements.

Data Analysis & Reporting

• Utilize claims data to identify trends, loss drivers, and areas for improvement.
• Prepare and present claim analytics reports to clients and senior leadership, offering strategic insights and recommendations.

Qualifications & Requirements

• Experience: Minimum 10 years of workers’ compensation claims management, advocacy, or risk consulting experience within an insurance brokerage, TPA, or carrier environment.
• Technical Knowledge: Strong understanding of workers’ compensation laws, claims handling best practices, and multi-jurisdictional compliance.
• Communication & Negotiation: Excellent advocacy, negotiation, and interpersonal skills, with the ability to effectively communicate with clients, carriers, and legal representatives.
• Analytical Skills: Ability to analyze claims data, identify patterns, and develop strategic solutions to minimize costs and improve claim outcomes.
• Technology Proficiency: Experience with claims management systems, risk analytics tools, and Microsoft Office Suite (Excel, Word, PowerPoint).
• Education & Certifications (Preferred):
  • Bachelor’s degree in Risk Management, Business, or a related field.
  • Industry designations such as AIC (Associate in Claims), ARM (Associate in Risk Management), or CPCU (Chartered Property Casualty Underwriter) are a plus.

Work Environment & Schedule

• Hybrid role – minimum three days in-office preferred.
• Occasional travel may be required for client meetings, claim reviews, or industry events.