Claims Advocate
2 weeks ago
Join the leading Workers' Compensation insurance provider in MN and immerse yourself in an environment that prioritizes both professional excellence and personal well-being. In this role, you'll be entrusted with managing lost time claims and intricate medical claims, utilizing your expertise to ensure successful resolutions. Collaboration is central to our approach, as you'll partner with diverse teams to navigate complex cases.
Do you thrive on making a real difference in people's lives? Are you equipped with sharp critical thinking and interpersonal skills? Join our team and play a pivotal role in ensuring successful outcomes for all parties involved in Workers' Compensation claims
As a Work Comp Claims Professional Rep, you'll be at the forefront of handling workers' compensation claims, focusing primarily on the state of MN. Dive into investigations, manage claims in alignment with state statutes and best practices, and navigate the complexities of lost wages and intricate medical claims. Working on multifunctioning team is what makes SFM unique and helps you to do your best work.
Enjoy the flexibility of hybrid or remote work, tailored to your location in MN, WI, SD, NE, or IA, with MN being the preferred hub.
At SFM, we believe in work-life balance, and are consistently ranked as a top employer. Experienced adjusters, elevate your career with us; your job title will be based on the experience you offer. Your expertise will shape your position. MN claims handling experience is a definite plus. Make your mark with us today and find out why SFM is the number WC carrier in Minnesota
Our benefits include:
Affordable Medical, Dental, Vision Insurance, HSA, FSAFlexible hybrid work environmentTraditional and Roth 401(k) plans with company matchCompany contributions to help pay off student loansMonthly home internet allowanceFree life insurance, STD & LTDOpportunities for annual gainshare bonus Pet insuranceGenerous PTO9 paid holidays Paid parental leaveAnnual company-wide volunteer dayDiscounts on gym memberships, fitness apps and weight loss programsAdoption financial assistanceResponsibilities:
Claims Management
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.Identifies, analyzes and attempts to resolves payment changes and errors on files. When unable to resolve, actively seeks out and works with Claims Technical to learn for future application.Manages data timely and accurately on files to be in compliance with state regulatory reporting requirements, rating bureau reporting mandates and internal data needs.Business Operations
Demonstrates the skills to independently handle medical only and routine to moderately complex lost time claims. Seeks out assistance when claims do not resolve timely. Participates in discussions on file strategy.Assists less experienced representatives in claim management, use of company resources and company services.Shows professionalism to internal and external customers. Professionally works with other team members to best serve all customers of the team. This includes, but is not limited to, covering for other team members when they are absent, being respectful of others, and the ability to successfully resolve conflict. Constructively works with team members and others in the company when service and business improvement opportunities are identified.Shares thoughts and ideas in team meetings and encourages others to do the same. Demonstrates and promotes positive behavior and attitude among team members.Participates in projects when asked.Identifies and communicates trending and claims management practices that could impact the team's book of business.Provides technical and marketing services in order to maintain agency and policyholder relationships so as to achieve success with new business goals, retention of renewals and loss experience consistent with team and company goals.Learns new jurisdictions when asked.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 skill in state regulatory reporting.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:
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. Regular attendance is required.
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
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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.
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