Job Description

This is a Senior Level position. We are looking for an energetic, confident, enthusiastic, self-starter Workers' Compensation Claims Advocate to join our growing team. This position will serve as an important liaison between client and carriers throughout the duration of the claims process with the goal to help provide successful, expedited resolutions to claims. The Advocate also serves as a resource to the sales and service teams in the overall WC claims handling and presentation of WC claim services to existing and potential clients.

The ideal candidate must have a clear and complete understanding of the workers' compensation claims process, including providing WC technical expertise to employers, interpret loss runs, establish action plans for resolution of claims, calculate X-mod projections, assess published X-mod, analyze claim exposures and its effects on employer premiums, facilitate communications between insurance carriers/adjusters and the employer and prepare reports and meet with clients.

Job Responsibilities:

This is a summary of the job responsibilities:

• Acts as an advocate and claim resource to provide support to clients, producers, and carriers related to WC claim status and claim handling.
• Monitor internal/external customer service claim questions/concerns and act as a contact for claim related questions and resource.
• Manage the claims process; collaborate with insureds/clients, producers and team members throughout the process which includes client advocacy (mitigating claims/exposure)
• Document, file and follow up on the claims ensuring they are progressing in a timely manner.
• Work with carriers, agents and clients to resolve complex claim issues. (U/W, Loss Control, etc)
• Create and manage loss detail reports as requested.
• Educate staff on specific coverage issues related to Serious and Willful, 132a, Coverage B, etc.
• Provide client services by educating clients on best practices on advanced claim issues on a consistent basis.
• Provide education and guidance on issues related to return to work, claim reporting, MPN, OSHA, etc.
• Proactively manages and leads claim reviews in accordance with claims service guidelines, including reviewing claims, assembling documents, ensuring carrier participation when necessary; conduct claim review meetings in person or via phone; managing the meeting with agreed upon timeframe, while driving towards positive claim results.
• Participates in current and prospective client meetings with sales and service teams and provides overview of WC claims management tailored to the concerns of the client.
• Provides initial and on-going advocacy on claims including detailed analysis, interpretation, consultation and negotiation of coverage and reserves;
• Maintains claim activities, update claim notes, attach and note communications/documentation.
• Manages subrogation and recovery situations by working closely with adjuster & client.
• Provides value added services to producers, focusing on account retention and obtaining new business.
• Attend and participate in on-site/off-site meetings regarding services delivery and/or stewardship.
• Provide advocacy on behalf of assigned clients relating to proper claims processing and may recommend securing advice from outside experts, as necessary. (Loss Control, HR, etc)
• Oversees the accuracy in client portals, loss runs, claim reports, etc.
• Approach client service by collaborating with other service teams to create a cohesive client service experience.
• Other duties as assigned.
• Make suggestions that you feel would improve WGBIB in satisfying our mission, meeting our goals, or making WGBIB a more beneficial place to work.
• Make a positive influence on the WGBIB team.

Position Requirements:

• Bachelors Degree or equivalent combination of education and experience
• 10 year + WC claim experience
• Broker experience (may include participating in claim reviews with brokers)

Company Description

We are an award-winning insurance brokerage with over 100 employees located in Orange County. We are poised for growth and our culture is outstanding. Our employees enjoy the fact that they are passionate advocates for clients in need. If you are looking for a fast paced, challenging role in the competitive and growing insurance industry, this is a great opportunity. At Wood Gutmann & Bogart Insurance Services, we provide a strong foundation for long-term success. We are well positioned to take advantage of the unlimited growth potential in the insurance arena and welcome highly talented and driven professionals to become a part of our growing team. For 30 years, we have been providing premier insurance solutions to businesses and individuals throughout California and we have no plans of slowing down.