Claims Advocate

CompScience•San Francisco, CA

1d•$80,000 - $120,000•Remote

About The Position

We are seeking a highly motivated Claims Advocate to serve as a trusted partner to clients throughout the workers’ compensation claims process. This role focuses on advocating for fair and timely claim outcomes, providing expert guidance, and delivering an exceptional client experience. The objective is to achieve best in class claims management to deliver best outcomes for the injured worker and employer.

Requirements

Possess a Bachelor’s degree or equivalent experience and 3+ years experience managing Workers’ Compensation claims (ideally in at least, CA and IL)
Experience presenting to and talking with employers to enhance claims management
Exhibit a thorough understanding of workers' compensation laws, regulations, and claims best practices, including effective strategies for timely claim reporting, medical management, and return-to-work programs.
Excellent communication and advocacy skills
Be a self-starter with the capacity to work independently and manage multiple priorities effectively within a dynamic, fast-paced, and evolving startup environment.

Nice To Haves

Showcase strong analytical and problem-solving skills, with experience in claims auditing and performance analysis, and maintain proficiency with claims management systems and data analysis tools.
Display excellent communication, negotiation, and interpersonal skills, enabling effective engagement and influence with internal and external stakeholders, and possess a proven ability to advocate effectively for both policyholders and claims examiners.
Technology oriented: Google Suite, Hubspot, Slack, among other tools.

Responsibilities

Manage relationships with external workers' compensation claims administrators, including insurance partners and Third-Party Administrators (TPAs) across multiple states.
Conduct regular audits of claims to ensure adherence to best practices and service level agreements.
Monitor and analyze partner performance, identifying areas for improvement and implementing corrective action plans
Act as a dedicated advocate for both claims examiners and policyholders, fostering clear and effective communication to resolve issues and ensure a transparent process.
Proactively communicate with employers to promote and ensure the adoption of claims management best practices, such as immediate reporting of claims, effective return-to-work/light-duty programs, and participation in periodic claims reviews.
Educate policyholders on strategies to manage claims effectively and reduce overall claims costs.
Support initiatives aimed at achieving best-in-class claims management, focusing on delivering positive outcomes for injured workers while minimizing costs for employers and CompScience.
Analyze claims data to identify trends, insights, and opportunities for program enhancement.