FULL_TIME

FEED

UNKNOWN

About the Role: Responsible for IOA insurance Claims Management activities including: client advocacy, service and communication, problem claim resolution, data analysis and action, monitoring triggered activities, claims reviews and audits, workers compensation claim oversight, reserve analysis, unit stat and stewardship reporting, client education and consulting, sales support, litigation process management, new client onboarding, intake process support, data management and entry, and Producer communication. Please note: If this position is posted as either fully remote and/or hybrid, in accordance with company policy, individuals residing within a 50-mile radius of a branch location may be required to work onsite in a hybrid capacity.

YEAR

DescriptionJob Description:Title: Claims Advocate – Risk ServicesFully remote | Experience/Book Focus: Commercial Auto, Trucking, Transportation, Property Cargo   Please note: If this position is posted as either fully remote and/or hybrid, in accordance with company policy, individuals residing within a 50-mile radius of a branch location may be required to work onsite in a hybrid capacity. Additionally, there may be occasions when on-site presence is necessary to meet specific business needs. Learn more about our locations here: <a href="https://ioausa.com/locations/" rel="nofollow noopener noreferrer" target="_blank">ioausa.com/locations</a> About the Role: Responsible for IOA insurance Claims Management activities including: client advocacy, service and communication, problem claim resolution, data analysis and action, monitoring triggered activities, claims reviews and audits, workers compensation claim oversight, reserve analysis, unit stat and stewardship reporting, client education and consulting, sales support, litigation process management, new client onboarding, intake process support, data management and entry, and Producer communication.   Key Responsibilities: <ul><li>Performance Standards: Meet all production, quality, and service expectations. </li></ul><ul><li>Client Service Excellence: Deliver outstanding service by anticipating client needs and responding promptly. </li></ul><ul><li>Client Advocacy: Serve as a dedicated advocate, providing high levels of ongoing support and consultation. </li></ul><ul><li>Problem Claim Resolution: Manage complex or delayed claims to ensure timely and favorable outcomes. </li></ul><ul><li>Loss Report Analysis: Review aggravated inequity loss reports and take appropriate corrective actions. </li></ul><ul><li>Activity Monitoring: Track triggered claim activities and implement necessary follow-up actions. </li></ul><ul><li>Claims Review & Auditing: Conduct and participate in formal claims reviews and audits. </li></ul><ul><li>Workers Compensation Oversight: Monitor workers compensation claims via the IOA Claims Portal and drive them to closure. </li></ul><ul><li>Reserve Accuracy: Perform reserve analysis to ensure timely and accurate case reserves in line with best practices. </li></ul><ul><li>Carrier Relationship Management: Build and maintain strong relationships with carriers to influence positive claim outcomes. </li></ul><ul><li>Claims Mediation: Act as an intermediary between clients and carriers to facilitate effective and timely resolutions. </li></ul><ul><li>Client Education: Provide ongoing education on statute changes, state-specific procedures, and claims best practices. </li></ul><ul><li>Trend Identification & Risk Mitigation: Identify claims trends, recommend risk mitigation strategies, and collaborate with Risk Advocates. </li></ul><ul><li>Sales Support: Assist with Producer presentations and contribute to sales efforts through claims insights. </li></ul><ul><li>Reporting & Documentation: Prepare and deliver stewardship and unit stat reporting in accordance with departmental standards. </li></ul>  Ideal Candidate Qualifications: <ul><li>5+ years of claims handling experience; preferred experience in an agency advocate or liaison role </li></ul><ul><li>Licensed Insurance Adjuster or state equivalent </li></ul><ul><li>Exceptional customer service, communication, multi-tasking, organizational, delegation, and decision-making skills </li></ul><ul><li>Ability to perform large work volumes with high accuracy </li></ul><ul><li>Proficiency in MS Office (Outlook, Word, Excel) </li></ul><ul><li>High School Diploma (or equivalent) </li></ul>  What We Offer: <ul><li>Competitive salaries and bonus potential </li></ul><ul><li>Company-paid health insurance </li></ul><ul><li>Paid holidays, vacations, and sick time </li></ul><ul><li>401K with employer match </li></ul><ul><li>Employee stock plan participation </li></ul><ul><li>Professional growth and career progression opportunities </li></ul><ul><li>Respectful culture and work/family life balance </li></ul><ul><li>Community service commitment </li></ul><ul><li>Supportive teammates and a rewarding work environment </li></ul>  What to Expect (Application Process): <ul><li>30-Minute Phone Screen, Online Assessments, and Interview(s) </li></ul>Salary Rangehe expected pay range for this position is $70,000 to $95,000 per year, depending on experience, relevant skills, and geographic location.Insurance Office of America is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Insurance Office of America

Claims Advocate - Risk Services (Trucking/Transportation)

Analysis Skills

Auditing

Best Practices

Cargo/Freight

Claims Management

Claims Processing

Consulting

Corporate Policies

Corrective Action

Customer Support/Service

Data Analysis

Data Entry

Data Management

Data Processing

Diversity

Documentation

Health Insurance

Insurance

Insurance Claims

Litigation

Microsoft Excel

Microsoft Office

Microsoft Outlook

Microsoft Word

Multitasking

Onboarding

Problem Solving Skills

Process Management

Relationship Management

Risk

Risk Analysis

Risk Management

Sales

Sales Management

Sales Support

Service Delivery

Stewardship

Stock Purchase Plans

Time Management

Trend Analysis

Trucking

Worker's Compensation

Jobvite Talemetry Organic Easy Apply

OTHER

In this role, you won’t just create care plans—you’ll guide members through every step of their journey, ensuring they receive the support and services needed to thrive. This role requires independence, strong time management, leadership capability, and comfort working in fast-paced, community-based environments.

Schedule: Monday – Friday | 8:30 AM – 5:00 PM Compensation: $30.00 – $35.00 per hour Location: Hybrid (El Dorado County / Placer County) FLSA Status: Non-Exempt This position is an individual contributor, not a People Manager.About Pacific Health Group At Pacific Health Group, we are at the forefront of revolutionizing health and wellness through innovation, compassion, and community-driven care. Our mission is to empower members, uplift families, and positively impact the communities we serve. Our Community Supports (CS) Program helps Medi-Cal members live more independently by addressing health-related social needs. In this role, you won’t just create care plans—you’ll guide members through every step of their journey, ensuring they receive the support and services needed to thrive.What This Role Looks Like (Day-to-Day Reality) This is a highly field-based role supporting members directly in the community.<ul><li>Manage a caseload of members with complex health and social needs</li><li>Spend approximately 65% of your time in the field (homes, shelters, community settings)</li><li>Conduct in-person visits, assessments, and follow-ups</li><li>Travel locally within hiring county</li><li>Coordinate services across healthcare, behavioral health, and community resources</li><li>Participate in community outreach efforts including events, partnerships, and local engagement</li><li>Provide mentorship and support to other care managers</li><li>Document in real-time or by end of day using internal systems This role requires independence, strong time management, leadership capability, and comfort working in fast-paced, community-based environments</li></ul>What You’ll DoCare Coordination & Case Management<ul><li>Conduct comprehensive member assessments to identify health and social needs</li><li>Develop and manage individualized care plans</li><li>Coordinate appointments, services, and long-term support systems</li><li>Ensure continuity of care and consistent follow-through</li></ul>Member Engagement & Advocacy<ul><li>Build strong, trusting relationships with members and their families</li><li>Provide ongoing support through phone, video, and in-person visits</li><li>Advocate for timely care, services, and equitable access to resources</li></ul>Community Outreach & Engagement<ul><li>Represent Pacific Health Group in the community through outreach events, partnerships, and local initiatives</li><li>Build and maintain relationships with community-based organizations, shelters, and service providers</li><li>Identify opportunities to expand community presence and improve access to services</li><li>Support outreach efforts that drive member engagement and program awareness</li></ul>Community Resource Navigation<ul><li>Connect members to housing, food access, workforce programs, childcare, and other services</li><li>Strengthen partnerships with community-based organizations</li><li>Identify gaps in resources and escalate needs for program improvement</li></ul>Leadership & Team Support<ul><li>Provide guidance, mentorship, and support to care managers within the program</li><li>Assist with onboarding and training of new team members</li><li>Promote consistency, collaboration, and best practices across the team</li></ul>Documentation & Compliance<ul><li>Maintain accurate and timely documentation of all member interactions</li><li>Ensure compliance with Medi-Cal, CalAIM, and Community Supports program requirements</li><li>Track progress, outcomes, and service delivery</li></ul>Team Collaboration<ul><li>Partner with interdisciplinary teams including behavioral health, outreach, and social services</li><li>Coordinate with healthcare providers and payers to ensure seamless care delivery</li></ul>Continuous Improvement<ul><li>Identify trends and gaps in services</li><li>Provide feedback to leadership to improve care coordination strategies and partnerships</li></ul>How Success Is Measured<ul><li>Member engagement and successful care coordination outcomes</li><li>Timely and accurate documentation</li><li>Ability to manage caseload independently and effectively</li><li>Quality of mentorship and team support provided</li><li>Strength of community partnerships and outreach engagement</li><li>Compliance with program and regulatory requirements</li></ul>Who Thrives in This Role<ul><li>Is comfortable working independently in the field</li><li>Can manage complex caseloads and competing priorities</li><li>Is a strong leader and team collaborator</li><li>Is proactive, resourceful, and solution-oriented</li><li>Thrives in fast-paced, community-based environments</li><li>Enjoys engaging with the community and building relationships</li><li>Is passionate about supporting high-acuity, underserved populations</li></ul>                              Equal Employment Opportunity Pacific Health Group, along with its divisions, is a proud Equal Opportunity Employer. We embrace diversity and are devoted to creating an inclusive environment for all employees. Our commitment is to ensure equal employment opportunities for every qualified candidate, irrespective of race, religion, gender, sexual orientation, gender identity, age, national origin, citizenship, disability, marital status, veteran status, or any other status protected by federal, state, or local laws. At Pacific Health Group, we recognize the importance of accessibility and are dedicated to providing reasonable accommodations for individuals with disabilities. We believe that our strength lies in our diversity, and we are committed to building a workforce that reflects the varied communities we serve. Join us in a workplace where everyone's contributions are valued and respected.Pre-Employment Requirements Employment is contingent upon the successful completion of our pre-employment process, which includes a background check and the submission of all required documentation and new hire paperwork.AI & Human Interaction (HI) in Recruitment Pacific Health Group is committed to fairness, equity, and transparency in our hiring practices. We use AI (Artificial Intelligence) tools to help match candidate resumes against our job descriptions, focusing on qualifications, skillsets, and location. All resumes that meet these criteria are then reviewed by HI (Human Interaction) — our recruiting and HR team. Pacific Health Group remains true to our Equal Employment Opportunity (EEO) statement, ensuring that every candidate is given fair and consistent consideration.RequirementsMinimum Qualifications<ul><li>Experience: 3–5 years in case management, social services, or healthcare</li><li>Experience with: Medi-Cal, CalAIM, and Community Supports programs (preferred)</li><li>Strong understanding of healthcare systems, managed care, and community resources</li><li>Excellent communication, empathy, and cultural competence</li><li>Strong organizational and time management skills</li><li>Must be proficient in technology, including case management systems, EHR platforms, and documentation tools</li><li>Ability to document in real-time and manage member data accurately</li><li>Comfortable navigating multiple systems and communication platforms</li></ul>Work Requirements<ul><li>Ability to travel locally within hiring county</li><li>Valid California Driver’s License and reliable transportation</li><li>Ability to work in a hybrid, field-based environment</li></ul>BenefitsCompensation & Benefits<ul><li>Hourly Range:$30.00 - $35.00, depending on experience, qualifications, and internal equity</li><li>Monthly stipend</li><li>160 hours PTO + paid sick time</li><li>11 paid holidays (including birthday and floating holiday)</li><li>4 paid volunteer hours per month</li><li>90% employer-paid employee-only medical benefits</li><li>Flexible Spending Account (FSA)</li><li>Short-term & long-term disability, AD&D</li><li>Employee Assistance Program (EAP)</li><li>401(k) with company match</li><li>Professional development opportunities</li><li>Quarterly in-person events</li><li>Employee discount programs</li></ul>

Advocate Jobs in Crystal, CA

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Advocate Jobs in Crystal, CA

Claims Advocate - Risk Services (Trucking/Transportation) Insurance Office of America

Community Support Lead Care Coordinator Pacific Health Group

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