Claims Advocate

Job Title: Claims Advocate

Schedule: In Office Mon-Fri

Department/Group: Commercial Claims

Travel Required: Not Required

Exempt, Non-exempt: Non-Exempt

Position Type: Full-Time

Location: Marcellus

Reports To: Claims Team Manager

Key Relationships: Risk Consultants, Agency Clients, Insurance Carrier Claim Adjusters, Agency Leaders

Position Summary

The Claims Advocate - Workers' Compensation is responsible for advocating for our commercial clients through the workers' compensation claim process. Reporting to the Claims Team Manager, this role manages an inventory of claims, coordinates communication between clients and carriers/TPAs, evaluates claim status and strategy, prepares and presents claim documentation, and supports timely resolution.

Job Duties

Claim Advocacy & Management

• Review, prioritize, and manage an assigned workers' compensation claim inventory.
• Analyze and evaluate claim positions and identify issues impacting outcomes (delays, disputed items, missing documentation, return-to-work barriers).
• Advocate for client priorities while maintaining productive working relationships with claim adjusters and other stakeholders.
• Recognize when to escalate significant claim issues and keep appropriate stakeholders informed.
• Meet with clients virtually or on-site as needed to coordinate coverage and/or claim resolution.

Communication & Customer Service

• Serve as a primary point of contact for clients on workers' compensation claim questions, status updates, expectations, and next steps.
• Communicate routinely with carrier adjusters/TPAs (and other parties as appropriate) to keep claims moving and address roadblocks.
• Bridge communication gaps between clients and carriers through clear and timely updates.

Documentation & Claim Support

• Prepare, organize, and present claim documentation, summaries, and reports to Risk Consultants, clients, and carriers/TPAs to support claim handling, strategy, and escalation.
• Maintain accurate internal claim notes, timelines, and supporting documentation to ensure continuity and accountability.
• Participate in formal claims review meetings, steward ships, and renewal meetings by presenting claim summaries, trends, and action plans.
• Document all claim activity in the agency management system, including notes, activities, and attachments/emails.
• Assist with internal reviews of clients’ experience modification factors.

Workers' Compensation Knowledge & Research

• Apply working knowledge of New York workers' compensation processes and requirements.
• Research other states' workers' compensation rules as needed and translate findings into practical guidance for clients and internal teams.

Internal Collaboration & Education

• Partner daily with Commercial Claims team members and Risk Consultants to align on strategy, timelines, and client messaging.
• Act as an internal resource/educator on workers' compensation claim topics, claim process expectations, and best practices for documentation and communication.
• Engage in continuous learning to stay current on common claim issues and evolving claim handling practices.

Behavioral Competencies

• Client-Focused:
  Maintains a strong service mindset and supports clients with professionalism, empathy, and responsiveness.
• Detail-Oriented:
  Tracks multiple moving parts, follows up consistently, and maintains accurate records.
• Clear Communicator:
  Communicates confidently and respectfully with clients, carriers/TPAs, and internal teams.
• Collaborative:
  Works effectively across teams to support client outcomes and consistent service.
• Continuous Learner:
  Stays current with workers compensation laws and deepens knowledge of all commercial lines coverages.

Knowledge, Skills, and Abilities

• Strong background in insurance claims handling with a focus on workers' compensation.
• Understanding of insurance coverage and the claims process; able to analyze claim positions and recommend practical next steps.
• Knowledge of New York workers' compensation statutes and the ability to research and apply other states' workers' compensation requirements.
• Strong written and verbal communication skills with a high level of professionalism.
• Excellent organization, time management, and follow-through with strong attention to detail.
• Ability to maintain confidentiality and exercise sound judgment.
• Proficiency with Microsoft Office; ability to navigate carrier/TPA systems and portals as needed.

Basic Qualifications

Experience:

Minimum of 3 years of experience working with insurance claims; workers' compensation experience strongly preferred.

Education:

Bachelor's degree preferred.

Licensing:
Must be a licensed claims adjuster.

Compensation details:  Yearly Salary

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