Workers Compensation Claims Consultant

Why Join M&G:

OUR CULTURE!!

We Continue to Win Awards and Achieve Honors for our Culture, Industry Expertise, and Services

• Central Coast Best Places to Work by Pacific Coast Business Times (2018-2026)
• Best Agencies to Work for by Insurance Journal (2017-2019, 2021, 2024-2026)
• Big "I" Best Practices Agency by Independent Insurance Agents & Brokers of America (2016-2025)
• Top 100 P&C Agencies (2023-2026)
• MVP Account Managers (Insurance Journal)
• 50 Fastest Growing Companies by Pacific Coast Business Times (2017 - 2025)
• Diamond Level Family Friendly Workplace by SLO Chamber of Commerce (2022 - 2025)

Workers' Compensation Claims Consultant

As part of a suite of value-added services we offer our clients, the Workers' Compensation Claims Consultant serves as a trusted resource for our commercial clients. The Workers' Compensation Claims Consultant helps clients navigate the claims process using responsive service, technical expertise, and collaborative communication. This role partners with clients, Risk Advisors, insurance carriers, and internal teams to resolve claims efficiently, reduce friction, and support positive outcomes for employers and injured workers.

How You will be Compensated:

• $33-$41/hr Depending on Experience
• Medical, Dental, Vision Insurance plans. We cover 98% of the premiums for most individual plans
• Free Employee Assistance Program
• Paid Holidays, Paid Sick Time, and Flexible Vacation Time
• Paid Parental Benefits
• Disability and Life Insurance
• 401(k) with 50% match
• Flexible Spending Plan (FSA) and Health Savings Account (HSA)

What You will Do:

• Claims Advocacy & Technical Expertise

• Investigates claims-related questions, requests, and discrepancies to ensure timely, courteous and knowledgeable responses to customer inquiries.

• Receives service requests from colleagues or customers and completes required actions by navigating numerous carrier websites or call centers.

• Protects confidential, private, and sensitive information by following HIPAA and other privacy rules and regulations.

• Applies working knowledge of the California Workers' Compensation system, claims practices, and compliance requirements to support cost containment and client objectives.

• Escalates complex client claims, coverage concerns, or carrier related matters to a Supervisor or senior team member.

• Continually expands technical knowledge of insurance products, carrier process, agency procedures, and relevant market or regulatory developments.?

• Maintains client files with accurate, timely, and thorough documentation in Applied EPIC, including Activities, attachments, correspondence and follow-up items.

• Reviews open and closed claims to identify trends, escalation concerns, and opportunities for improved outcomes.

• Data Analytics & Reporting

• Orders Loss Runs (reports) from various sources to track claims and advocate for clients.

• Reviews and translates loss runs and claims data into client-ready summaries, dashboards, and visual reports.

• Applies expertise in experience modification (X-Mod) calculations to education, analysis, forecasting, and claims impact evaluations.

• Utilizes emerging analytical tools to improve insight, efficiency, and reporting quality.

• Client Engagement & Collaboration

• Builds relationships and strengthens partnerships by using active listening, creative problem-solving, empathy, tact and diplomacy.

• Maintains a concern for timeliness and accuracy when interacting with clients, claimants, department staff, and carrier personnel to minimize potential for errors & omissions claims.

• Demonstrates teamwork and a positive attitude under pressure

• Occasionally may provide leadership, work assignments, evaluation, training, and guidance to others.

Who you Are:

• You exhibit a professional demeanor and positive work ethic.
• You use excellent written and verbal communication skills in your interactions.
• You are highly organized with strong attention to detail.
• You can apply flexibility when required and adapt to urgent needs.
• You make use of your sound judgement, sharp analytical skills, and innate critical thinking and problem-solving skills.

Qualifications

• Bachelor's Degree or equivalent professional experience
• 2+ years California Workers' Compensation insurance or claims experience OR 2+ years California Workers Compensation exposure in an HR capacity
• Proficiency in Microsoft 365 and ability to learn new software applications