Job DescriptionAs the Workers' Compensation Claims Advocate's at Trucordia you will serve as a strategic advisor and liaison between clients, insurance carriers, and third-party administrators (TPAs). This role ensures that claims are managed effectively, supports clients in navigating complex claim processes, and promotes best practices in workers' compensation programs.
Duties and Responsibilities:- Act as the primary point of contact for clients regarding workers' compensation claims. Advocate for aggressive investigation of questionable claims and use of sub-rosa surveillance when appropriate.
- Monitor open claims to ensure timely and appropriate handling by Carriers/TPAs. Provide guidance on claim strategy and resolution options. Identify opportunities for claim closure, cost containment, and fraud prevention.
- Assist clients in understanding claim status, medical treatment plans, and return-to-work strategies. Educate clients on the use of Medical Provider Networks (MPNs) and help identify quality care providers.
- Work with clients and Carriers/TPAs to establish and enforce claims handling protocols.
- Evaluate Carriers/TPA's bill review and utilization review programs.
- Ensure quarterly claim reviews are conducted (In-person or teams meeting as appropriate), assist in preparing claim summaries, and presentations for client meetings. Ensure that a quarterly claim review is conducted close to unit stat filing date.
- Complete WC Claim Call Reports that are professional in appearance and consistent in accordance with established standards and provide copies to Producers to support client discussions.
- Review and analyze loss runs, claim trends, and reserve accuracy.
- Prepare projected experience mods ratings and using the established format to explain increase or decrease.
- Stay current on legislative changes and industry trends affecting workers' compensation. To ensure claims are managed in accordance with state regulations.
- Assist Trucordia Account Managers in obtaining experience rating worksheets and responding to WC claim questions.
- Provide training and resources to clients on workers' compensation procedures and process, including the interactive process when returning an employee to work with permanent work restrictions.
- Collaborate with Producers and Account Managers to support client retention and new business development.
Qualifications- Bachelor's Degree or higher is desired but not required if appropriate work experience is present
- 7-10+ years CA workers' compensation claims handling or consulting - required
- SIP certificate required
- Strong understanding of CA WCAB processes, reserves, litigation strategy - required
- Ability to interpret loss runs, mod worksheets, and actuarial data
- Excellent communication skills - both written and oral
- Proficiency with Excel, Word, and RMIS platforms
- The ability to be a team player and proactively support others
Additional InformationPlease see our company Benefits:- Medical, Dental, Vision
- Life Insurance and AD&D
- FSA / HSA
- Accident
- Critical Illness
- Hospital Indemnity
- Supplemental Health Insurance
- EAP
- Pet Insurance
- 11 Paid Holidays
- Flexible PTO
- 401K
