Claims Advocate

4 weeks ago

Des Moines IA United States SFM Companies (SFM Mutual Insurance) Full time
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.

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