Responsibilities
The Account Claims Advisor serves as Midwest Employers Casualty's primary claims consultant and strategic claims resource for assigned active accounts. This role combines advanced workers' compensation claims expertise with client-facing consultative services to strengthen customer relationships, improve claim outcomes, and demonstrate the MEC Difference.
The position proactively identifies claim intervention opportunities through claim reviews, analytics, alert monitoring, assigned PowerComp claim management, and direct engagement with customers, TPAs, brokers, and internal stakeholders. The Account Claims Advisor provides technical claim guidance, conducts claim consultations, leads account claim reviews, and develops actionable strategies designed to mitigate loss costs, improve outcomes, and enhance customer retention.
The role acts as a bridge between MEC Claims, Underwriting, Business Development, Medical Management Consultants, Claims Attorneys, and external claim partners to ensure MEC delivers a consistent and differentiated experience to active accounts.
Key responsibilities include but are not limited to:
- Serve as a trusted claims advisor for assigned active accounts, TPAs, brokers, and customer stakeholders.
- Provide technical claims leadership that supports Account Executive-owned customer strategies and claim-focused account priorities.
- Lead claim consultations and strategic discussions on complex workers' compensation claims.
- Conduct virtual and in-person claim reviews, roundtables, customer presentations, and claim-focused account discussions.
- Translate claim data, trends, and technical issues into practical recommendations for clients and claim administrators.
- Identify and communicate claim success stories that demonstrate the MEC Difference.
- Support retention and account growth through proactive claims engagement.
- Monitor and review claim alerts, predictive analytics, and data-driven indicators to identify intervention opportunities.
- Review active claims within customer retentions to identify emerging risk, reserve concerns, settlement opportunities, and claims requiring escalation.
- Coordinate timely intervention strategies with TPAs, customers, Medical Management Consultants, Claims Attorneys, and other MEC resources.
- Track outcomes and measure the effectiveness of claim interventions.
- Manage an assigned caseload of PowerComp claims in accordance with MEC Claim Best Practices.
- Identify reserves and support accurate reserve evaluation based on claim facts, exposure, medical status, litigation status, and expected outcomes.
- Work with accounts, TPAs, and MEC internal resources to identify opportunities to mitigate claim exposure and move appropriate claims toward settlement.
- Maintain current documentation, diary control, and action plans that support reserve adequacy, claim mitigation, and settlement execution.
- Escalate claim issues, reserve concerns, and settlement barriers when additional MEC resources or leadership attention is needed.
- Evaluate workers' compensation claims for exposure, reserving adequacy, settlement potential, and claim management opportunities.
- Utilize advanced analytics, predictive modeling, and AI-driven tools to support claim evaluation and recommendations.
- Provide guidance regarding medical management, litigation strategy, settlement planning, vocational services, structured settlements, and vendor utilization.
- Influence TPAs and claim administrators to adopt MEC-recommended claim handling and mitigation strategies.
- Support claim resolution efforts by identifying opportunities to mitigate loss costs and accelerate resolution.
- Partner with Account Executives, Underwriting, Business Development, Claims, and Client Services to align claims engagement with customer strategy.
- Participate in customer presentations and claim-focused account discussions.
- Serve as a subject matter expert regarding MEC claims services, analytics, and consultative resources.
- Effectively communicate claim trends, emerging risks, and opportunities identified within the organization.
- Align claim engagement activities with MEC service models, active account needs, and Account Executive-led customer strategies.
- Support proactive claim-level interventions for concierge and consultative accounts.
- Deliver targeted claim reviews for accounts experiencing adverse trends, large losses, or identified concerns.
- Assist in developing account-specific claim action plans designed to improve performance and strengthen customer relationships.
- Document consultation recommendations, outcomes, and customer value delivered.
Qualifications
- Bachelor's degree preferred.
- Minimum 10 years of workers' compensation claims experience.
- Advanced knowledge of workers' compensation claim management, reserving, litigation management, and settlement strategies.
- Strong consultative and influence management skills.
- Ability to analyze complex claim issues and develop practical solutions.
- Ability to communicate effectively with senior-level customer, TPA, and broker contacts.
- Demonstrated ability to influence outcomes without direct authority.
- Strong organizational, presentation, and relationship management skills.
- CPCU, AIC, ARM, or comparable professional designation preferred.
- Ability to travel as needed for account visits, claim reviews, conferences, and customer meetings.
