[Hiring] Senior Claims Analyst @Enlyte

Role Description

Are you ready to take your workers' compensation expertise to the next level—from the comfort of your home office? Join our team as we navigate complex claims, advocate for injured workers, and deliver exceptional outcomes for our clients.

• Independently investigates, evaluates, and resolves assigned Workers’ Compensation claims of a more complex or litigated nature in a timely manner in accordance with legal statutes, policy provisions and company guidelines.
• Evaluate claimant eligibility; communicate with attending physician, employer and injured worker.
• Manage high exposure, complex and catastrophic claims.
• Work with both the claimant and their physician to medically manage the claim, from initial medical treatment to reviewing and evaluating ongoing treatment and related information.
• Work directly with employers to facilitate a return to work, either on a full-time or modified duty basis.
• Confirm coverage and applicable insurance policy or coverage document and statutory requirements.
• Identify potential for third party recovery, including subrogation, Second Injury Fund or other fund involvement (when applicable) and excess or reinsurance reimbursement. Pursue the process of reimbursement and complete posting of recovery to the claim file, where appropriate.
• Identify potential for disability or pension credits or offsets and apply same where appropriate.
• Ensure timely denial or payment of benefits in accordance with jurisdictional requirements.
• Establish claim reserve levels by estimating the potential exposure of each assigned claim, establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure.
• Establish compensability status through case investigation and evaluation and application of jurisdictional statutes and laws.
• Manage diary in accordance with Best Practices and complete tasks to ensure that cases move to the best financial outcome and timely resolution.
• Where litigation is filed, evaluate exposure and work with defense counsel to establish strong defenses, prepare litigation plan of action, set legal reserve and manage litigation over life of claim.
• Close all files as appropriate in a timely and complete manner.
• Maintain closing ratio as directed by management team.
• Oversee and coordinate medical treatment for injured employees and provide information to treating physicians regarding employees’ medical history, health issues, and job requirements; provide direction to assigned nurse case manager where applicable.
• Complete PARs (payment authorization request) when applicable.
• Comply with all excess and reinsurance reporting requirements; manage self-insured retention reporting.

Qualifications

• High School diploma required. Associate’s or Bachelor’s degree preferred, or five or more years of equivalent work experience required in an insurance, medical/health or legal related industry.
• Proficient with MS Excel and Word.
• Computer experience with related claims software.
• Excellent verbal and written communication skills.
• Proven interpersonal skills with all levels of personnel.
• Superior organizational skills.
• Customer-focused orientation.
• Teamwork and promotes cooperation and commitment within team.
• Time management and ability to control time to accomplish goals.
• Hard working, diligent, reliable, and has initiative.
• Expertise in Workers’ Compensation and related claims handling practices and ability to apply same.
• Deep knowledge of client and carrier claims procedures.
• Significant understanding of self-insured retention, excess and reinsurance reporting.

Desired Skills and Experience

• Completion of Workers’ Compensation training courses internally and/or externally in all significant areas affecting Workers’ Compensation claims handling and practices.

Benefits

• Medical, Dental, Vision.
• Health Savings Accounts / Flexible Spending Accounts.
• Life and AD&D Insurance.
• 401(k).
• Tuition Reimbursement.
• An array of resources that encourage a lifetime of healthier living.
• Compensation ranges from $53,000 - $77,000 annually, based on skills, experience, and education.