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Workers Comp Claims Advocate

4 months ago

Tampa, United States Prestige Employee Administrators Full time

**Company Overview**:For more than 25 years, PrestigePEO has provided cost-effective employee benefits and HR services, transparent pricing, and personalized, quality service to every client. We go the extra mile to develop long-term relationships and build strong partnerships with each client we serve. We help our clients focus on running—and growing—their businesses. Bonded by shared goals, we’re a data-driven and results-focused company committed to solving any HR issue, big or small.

**S**UMMARY**
The Workers Comp Claims Advocate is part of the Workers’ Compensation Claims team and will be responsible for claims investigation, claim reporting, and timely, effective claim management of workers compensation claims**. **The **Claims Advocate **will report to the Claims Manager. This position works collaboratively with our Clients, insurance carriers, and loss control personnel to effectively reduce and mitigate our workers compensation exposures. This position also works collaboratively with our underwriters, and other internal departments. The New York salary range is $55,000 - $75,000 based on experience.

**RESPONSIBILITIES**:

- Timely review assigned new employee injuries by contacting (if necessary) our client employer, the injured worker, his/her supervisor, employee witnesses and/or reviewing all information received related to the work-related incident and promptly forward findings to Claims Manager.
- Ensure injured worker has been offered initial medical treatment
- Check policy and verify that a new claim is within policy period.
- Determine carrier and report claims
- Investigate and discuss with supervisor possible claims for subrogation
- Coordinate modified duty with client employer to return injured worker immediately, when appropriate, to work
- Monitor assigned claims to bring to closure, via prompt employer side actions.
- Maintain organized claim files.
- Monitor medical treatment to ensure the injured worker is attending scheduled appointments, continues to work and/or can be placed back to work.
- Complete forms when requested - including wage statements & return to work.
- Determine when additional resources may be necessary, such as medical case management, vocational rehabilitation counseling, legal, surveillance, etc., and bring recommendations to Claims Manager
- Maintain appropriate and professional communication with insurance adjusters, clients, injured worker, and other appropriate persons involved - by reading adjuster notes, and/or brief well-spaced calls to adjuster, client and/or injured worker.
- Ability to work with Insurance Carrier or Third-Party Administrator (TPA) staff, from the adjuster’s notes, on best practices and that cost of claims are being control through adjuster’s effective diary management and oversight of claim.
- Work with HR team on any lost time or modified duty claims
- Provide exceptional internal and external customer service

**REQUIREMENTS**:

- Ability to work independently and multi-task
- Strong analytical and problem-solving skills and sound judgment
- Must possess superb Microsoft Office Applications skills
- Exceptional written, verbal communication skills
- Excellent problem-solving, interpersonal, and organizational skills
- Demonstrate an open-minded, team-oriented, and collaborative work style
- Ability to work in dynamic, rapidly changing environment, adapting to changing requirements and collaborating with a wide range of colleagues
- Detail-oriented ability to self-direct, prioritize work, and meet deadlines

**EDUCATION AND EXPERIENCE**
- Bachelor's degree or equivalent combination of experience and education
- Minimum of 2 years’ claims experience
- Prior PEO experience is preferred
- ClientSpace and PrismHR knowledge is a plus

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