Claims Advocate III-

Amynta Group; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a Claims Advocate III to manage moderate to complex workers’ compensation claims. This role involves working independently, mentoring less experienced associates, and leading special projects. The ideal candidate will possess strong analytical, problem-solving, and communication skills, ensuring effective management of claims from initiation to resolution. If you have a passion for claims management and are looking for an opportunity to make a significant impact in a supportive environment, this position could be your next career move.

Qualifications

• Requires a minimum of five years of related experience.
• Four-year college degree preferred along with adjuster license.

Responsibilities

• Handle moderate to complex workers’ compensation claims.
• Conduct investigations and negotiate settlements within authority.

Skills

Analytical Skills

Problem-Solving Skills

Communication Skills

Organizational Skills

Time Management Skills

Presentation Skills

Education

Four-Year College Degree

Adjuster License

Certifications

Job description

We’re thrilled that you are interested in joining us here at the Amynta Group!

A Claims Advocate III is an experienced worker's compensation technician who can work independently with minor supervision. This position is assigned special projects, serves as a mentor to less experienced associates, assists with training and development, may present educational topics, may serve as a Team Lead if needed, and may conduct agency visits and claims reviews.

Complexity of Duties: Works on problems of diverse scope where analysis of data requires evaluation of identifiable factors. Demonstrates good judgment in selecting methods and techniques for obtaining solutions.

Duties include:

• Handling all various aspects of moderate to complex workers’ compensation claims.
• The Claims Advocate III has a reserve and settlement authority based on Leadership recommendations.

Leadership Received: Needs minimal direction. Works from policies and general objectives with functional guidance; seeks guidance on unusual cases or above authority levels.

Knowledge, Skills, Abilities: Manages moderate to complex claims. Strong analytical and problem-solving skills. Ability to communicate all of the claim’s aspects in a clear and concise manner to business partners. Strong organizational and time management skills. Strong presentation skills preferred.

Essential Functions:

• Conduct three-point contacts.
• Determine compensability.
• Issue workers’ compensation benefits.
• Develop plans of action to resolution, coordinate return to work efforts and approved medical payments.
• Investigate subrogation and negotiate limited settlements within authority level.
• Maintain contact with policyholders and injured workers.
• Ensure claims files are appropriately documented.
• Complete and file appropriate FROI and SROI’s as required by individual State Workers’ Compensation Statute and EDI reporting regulations.
• Manage claims in accordance with AWCS best practices.
• Employ appropriate claims management techniques and direct intervention (referrals for nurse case management, independent medical examinations, utilization review) to manage each claim.
• Make decisions within delegated authority.
• Have a solid understanding of all legislative requirements and can take direction to meet those requirements in a prudent business manner.
• Evaluate files for settlement.
• Negotiate settlements.
• Manage litigation process.
• Maintain a license for all states and products serviced as required.
• Comply with all quality control standards set by the company for the handling of claims.
• Comply with all procedures set forth by the company for performing the job as it relates to the various components of claim administrative services.
• Manage litigated claims in accordance with best practices. Obtain appropriate litigation budgets and develop appropriate plans of actions.
• Review files for Medicare reporting.
• Maintain Reinsurance Reporting updated.

Education: Four-year college degree preferred. Adjuster license and/or certifications preferred.

Experience: Typically requires a minimum of five plus years of related experience.

Physical Requirements: Works in an office or virtual work environment using a computer for a significant portion of the workday.

The Amynta Group (the “Company”) is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of any ground of discrimination protected by applicable human rights legislation.

Applicants with disabilities may be entitled to reasonable accommodation throughout the recruitment process in accordance with applicable human rights and accessibility legislation.