Claims Advocate III

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, may do agency visit, claims reviews etc.

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 presentations 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.
• Investigates Subrogation and negotiate limited settlements within authority level.
• Maintains contact with policyholders and injured workers.
• Ensure claims files are appropriately documented.
• Completes and files appropriate FROI and SROI’s as required by individual State Workers’ Compensation Statute and EDI reporting regulations.
• Manages claims in accordance with AWCS best practices.
• Employs appropriate claims management techniques and direct intervention (referrals for nurse case management, independent medical examinations, utilization review) to manage each claim.
• Makes decisions within delegated authority.
• Have 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.
• Manages litigation process.
• Maintains 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.
• Manages litigated claims in accordance to Best Practices. Obtains appropriate litigation budgets and develops appropriate plans of actions.
•  Makes decisions within delegated authority.
•  Reviews files for Medicare reporting.
• Maintains Reinsurance Reporting updated.

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

Experience: Typically requires a minimum 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. The information collected is solely used to determine suitability for employment, verify identity and maintain employment statistics on applicants.

Applicants with disabilities may be entitled to reasonable accommodation throughout the recruitment process in accordance with applicable human rights and accessibility legislation. A reasonable accommodation is an adjustment to processes, procedures, methods of conveying information and/or the physical environment, which may include the provision of additional support, in order to remove barriers a candidate may face during recruitment such that each candidate has an equal employment opportunity. The Company will accommodate a candidate to the point of undue hardship. Please inform the Company's personnel representative if you require any accommodation in the application process.