CoAdvantage
  • - Risk
  • Sarasota, FL, USA
  • Full Time

CoAd Summary:

CoAdvantage, a portfolio company of Morgan Stanley Global Private Equity, provides human resource solutions to small and mid-sized businesses.  Headquartered in Tampa, Florida, CoAdvantage serves approximately 4000 clients representing more than 90,000 worksite employees in all 50 states through our 10 regional office locations.  The passion, commitment and expertise of our Associates allow us to deliver outstanding HR services to our clients, from entrepreneurial startups to mature business enterprises.  CoAdvantage's resources help America's business community grow and thrive!

Position Summary: 

The Claims Specialist is responsible for managing a caseload of medical only, lost time, high complex and litigated files through resolution while practicing pro-active claims and litigation management. This individual is responsible for effective relationships with clients, insurance carriers, third party administrators (TPA), external vendors and internal departments/personnel.

 

Essential Job Functions:

  • Works closely with the Claims Manager relating to claims process for compliance with regulatory requirements, company best practices and policies, and industry standards
  • Ensures compliance with carrier requirements and claims management protocols
  • Provides client and injured workers support in the claim process including but not limited to reporting, identification of red flags or issues outside industry standards and company policies
  • Participates in claim reviews including input relating to action plans and monitoring of progress of plan to closure
  • Attend and participate in mediations, depositions and hearings as necessary
  • Communicate with clients, injured employee's, carriers, attorneys and other vendors in a professional and timely manner
  • Prepare reports as needed including, but limited to, wage statements, client claims summaries and loss runs
  • Assist with development of metrics reports to measure overall claims management performance
  • Perform other duties as assigned

Required Skills and Experience:

  • Minimum of 3 years lost time and litigation experience with workers' compensation claims
  • Working knowledge of commercial insurance claim operations
  • Experience with federal and state workers' compensation laws and regulations
  • Experience working with carriers, third-party administrators, managed care organizations, and medical providers
  • Good interpersonal and negotiation skills
  • Working knowledge of claims management systems and computer systems including Word and Excel
  • Fluent in English, bilingual in Spanish helpful
  • PEO Experience a plus

Educational and Professional Licensing or Certification Requirements:

  • Minimum Bachelor's degree
  • Adjuster's license preferred

 

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