Claims Advocate

Reagan Companies•Village of Marcellus, NY

26m•Onsite

About The Position

The Claims Advocate - Workers' Compensation is responsible for advocating for our commercial clients through the workers' compensation claim process. Reporting to the Claims Team Manager, this role manages an inventory of claims, coordinates communication between clients and carriers/TPAs, evaluates claim status and strategy, prepares and presents claim documentation, and supports timely resolution.

Requirements

Strong background in insurance claims handling with a focus on workers' compensation.
Understanding of insurance coverage and the claims process; able to analyze claim positions and recommend practical next steps.
Knowledge of New York workers' compensation statutes and the ability to research and apply other states' workers' compensation requirements.
Strong written and verbal communication skills with a high level of professionalism.
Excellent organization, time management, and follow-through with strong attention to detail.
Ability to maintain confidentiality and exercise sound judgment.
Proficiency with Microsoft Office; ability to navigate carrier/TPA systems and portals as needed.
Experience: Minimum of 3 years of experience working with insurance claims; workers' compensation experience strongly preferred.
Licensing: Must be a licensed claims adjuster.

Nice To Haves

Education: Bachelor's degree preferred.

Responsibilities

Review, prioritize, and manage an assigned workers' compensation claim inventory.
Analyze and evaluate claim positions and identify issues impacting outcomes (delays, disputed items, missing documentation, return-to-work barriers).
Advocate for client priorities while maintaining productive working relationships with claim adjusters and other stakeholders.
Recognize when to escalate significant claim issues and keep appropriate stakeholders informed.
Meet with clients virtually or on-site as needed to coordinate coverage and/or claim resolution.
Serve as a primary point of contact for clients on workers' compensation claim questions, status updates, expectations, and next steps.
Communicate routinely with carrier adjusters/TPAs (and other parties as appropriate) to keep claims moving and address roadblocks.
Bridge communication gaps between clients and carriers through clear and timely updates.
Prepare, organize, and present claim documentation, summaries, and reports to Risk Consultants, clients, and carriers/TPAs to support claim handling, strategy, and escalation.
Maintain accurate internal claim notes, timelines, and supporting documentation to ensure continuity and accountability.
Participate in formal claims review meetings, stewardships, and renewal meetings by presenting claim summaries, trends, and action plans.
Document all claim activity in the agency management system, including notes, activities, and attachments/emails.
Assist with internal reviews of clients’ experience modification factors.
Apply working knowledge of New York workers' compensation processes and requirements.
Research other states' workers' compensation rules as needed and translate findings into practical guidance for clients and internal teams.
Partner daily with Commercial Claims team members and Risk Consultants to align on strategy, timelines, and client messaging.
Act as an internal resource/educator on workers' compensation claim topics, claim process expectations, and best practices for documentation and communication.
Engage in continuous learning to stay current on common claim issues and evolving claim handling practices.