Claims Specialist, Workers Compensation

Job Description

Job Description

Company Description

Extraordinary opportunity. Exceptional experience.

Sometimes in life, you find yourself in the right place, at the right time, looking at an opportunity so extraordinary it cannot be ignored. At Trucordia, our company is built on wildly successful businesses in our communities across the country, and now we’ve come together to create the next great insurance brokerage. We offer an unrivaled combination of people, tools and solutions, and deliver exceptional experiences and opportunities for our employees, clients and stakeholders.

We celebrate both individual successes and collective accomplishments, making sure the industry recognizes the remarkable company we’re building together, as well as the impact we’re having on our clients and communities. Ranked as one of the fastest-growing companies in the U.S. for three consecutive years, we have more than 5,000 team members across 200 offices across the country, who actively, genuinely care about our clients, each other and the quality of our work, and in every interaction, represent a company that people want to work for and do business with.

 

Trucordia Values

1. We actively, genuinely CARE about our clients, each other and the quality of our work, and in every interaction, represent a company that people want to work for and do business with.
2. We COLLABORATE continuously because, together, we are more powerful and make amazing things happen for our clients and company.
3. We LEAD with intelligence, hunger, curiosity, energy and a future-focused attitude of “what’s next”?
4. We are RESULT-ORIENTED , growth-focused and driven to out-perform expectations of what an insurance brokerage can achieve.
5. We CELEBRATE both individual successes and collective accomplishments, making sure the industry recognizes the remarkable company we’re building together, as well as the impact we’re having on our clients and communities.

Job Description

As 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 Information

Please 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

Trucordia Insurance Services, LLC and its affiliates (collectively, the “Company”)  is aware of scams involving false offers of employment with the Company. The false offers use fake websites, email addresses, group chats and text messages. The Company does not (a) interview prospective candidates via instant message or group chat; (b) request banking or credit card information during the interview process; or (c) require candidates to purchase products or services or process payments on its behalf as a condition of any employment offer.

Trucordia is an equal opportunity employer. We believe that every employee has the right to work in an environment that is free from all forms of discrimination. It is our policy that all decisions involving any aspect of the employment relationship such as hiring, compensation and training, promotions, transfers, discipline, and termination will be based on merit, qualifications, and abilities. Such decisions will be made without regard to age, ancestry, color, race, national origin, disability, protected medical condition, genetic information, military service, veteran status, citizenship status, religion, creed, sex, gender, gender identity, sexual orientation, pregnancy, childbirth, marital status, or any other condition, characteristic or activity protected by law. Discrimination based on any of these factors is contrary to our operating philosophy.  Attention Recruitment Agencies: Trucordia does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered property of Trucordia, and we will not be obligated to pay a referral fee. This includes resumes submitted directly to hiring managers without contacting Trucordia's Talent Acquisition Department.