Qureos Mentor

Encova Insurance

<div>The salary range for this job posting is $49,225.00 - $78,759.00 annually + bonus + benefits. Pay Type: Salary<div></div><div><i>
The above represents the full salary range for this job requisition. Ultimately, in determining your pay and job title, we'll consider your location, education, experience, and other job-related factors, and will fall within the stated range. Your recruiter can share more information about the specific salary range during the hiring process.</i></div><div></div><div><i>
The actual salary range for candidates who reside in Pennsylvania is $53,241 - $85,186 </i>annually + bonus + benefits. Pay Type: Salary</div><div></div><div>
While we may prefer candidates who can work remote in Pennsylvania, we will consider those who live in any of our listed payroll approved states.</div><div></div><div>
Ideal candidates will have Workers' Compensation claims handling experience in Pennsylvania. Maryland, Delaware, DC or New Jersey workers compensation claims handling would be a plus.</div><div></div><div>
The position reports to the Director, Workers' Compensation Claims.</div><div></div><div>
Are you a Referral?</div><div>
If you know a current Encova Insurance associate and would like to apply as a referral, please encourage them to submit your referral information before you submit your application. You will receive an email with a direct URL link to the Job Posting of interest. Applying through this URL link will create your referral relationship for our Talent Acquisition Team.</div><div></div><div>
Unique residence requirements are listed in each job posting, please review closely for details.</div><div>
Encova is only able to employ associates who reside and work within specific U.S. states. Our current policies are based on the laws in states in which we are registered for payroll. Our current footprint includes:</div><div>
Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, Wisconsin.</div><div></div><div>
JOB OBJECTIVE:</div><div>
The Medical Only Claims Specialist, Workers&rsquo; Compensation manages a high frequency desk, which includes primarily medical only claims. The Medical Only Claims Specialist is responsible for the investigation, evaluation, and determination of compensability for work-related injury and disease claims following established guidelines to determine benefit eligibility. The position&rsquo;s objective is to provide superior service in a cost-effective manner to achieve best possible outcomes as well as proactively collaborate across the enterprise to ensure alignment of objectives and foster continuous improvement.</div><div></div><div>
ESSENTIAL FUNCTIONS:<br>
1. Gathers relevant facts by performing three-point contacts with involved parties and completing a thorough claim investigation prior to issuing a compensability determination.<br>
2. Decides the outcome of claims using sound judgment and applying established policy, procedures, regulations, and guidelines.<br>
3. Evaluates and establishes an action plan to manage benefits associated with primarily medical only and occupational disease claims to their most cost-effective conclusion.<br>
4. Determines eligibility of benefits once medical treatment plans have been secured and processed within the designated authority levels.<br>
5. Actively identifies and develops the investigation of and pursuit of subrogation recoveries when possible.<br>
6. Utilize proactive reserving behaviors to ensure adequate case reserves which reflect the probable ultimate outcome based on the current known circumstances throughout the life of the claim.<br>
7. Consults with lost time claims specialists and/or complex claims specialists, director or Claims Product and Operations staff, as needed.<br>
8. Analyzes reports from external resources such as physicians, attorneys, and/or vocational rehabilitation experts to evaluate and adjust claim strategies as needed.<br>
9. Evaluates and negotiates claim settlements utilizing human relation skills and technical knowledge to achieve the best possible outcome.<br>
10. Consults with assigned claim director if the loss becomes more complex or presents increasing financial exposure.<br>
11. Effectively and independently uses available resources to prioritize, organize, and complete work in a timely manner to meet jurisdictional requirements, timeframes, and internal metrics.<br>
12. Follows established claims best practices related to medical management, litigation, fraud/abuse and recovery.<br>
13. Presents claims and participates in discussion at team staffing.<br>
14. Works collaboratively with the injured worker, employer, outside counsel, and health and rehabilitation professionals to manage the claims costs and promote quality medical care.<br>
15. Along with the claim director, regional vice president and other claims staff, participates in claim reviews, onboardings, etc. for our policyholders and agents.<br>
16. Proactively collaborate with our policyholders to ensure alignment of objectives and foster continuous improvement.</div><div></div><div>
OTHER FUNCTIONS:<br>
1. Nonessential function: other duties as assigned.</div><div><br>
KNOWLEDGE, SKILLS AND ABILITIES:<br>
<ul><li>Bachelor&rsquo;s Degree from an accredited college or university is preferred.</li><li>One year of experience in the field of insurance, customer service, claims investigation, legal, rehabilitation, or medical claims processing required. Workers&rsquo; compensation claims experience and licensure preferred.</li><li>Must pass the claims adjuster license exam(s) as assigned within 6 months of being hired.</li><li>Preference may be shown to candidates with multiple state claims management experience.</li><li>Ability to use logic and sound reasoning to identify alternative solutions for problem-solving.</li><li>Strong written and verbal communication skills.</li><li>Strong analytical skills.</li><li>Ability to multitask and manage time effectively and productively.</li><li>Work effectively independently as well as in a team environment.</li><li>Develop and maintain strong, effective internal and external relationships.</li><li>Work effectively in a paperless environment.</li><li>Skilled in the use of laptops, claims management systems, and other typical business-related programs such as Microsoft Office suite.</li></ul></div><div><i><br>
This position has been evaluated in accordance with the Americans with Disabilities Act. Encova Insurance makes every effort to reasonably accommodate disabilities to permit performance of the essential functions and candidates who need such accommodation are encouraged to seek it. This description reflects the nature and level of work performed by associates in this position. It is not an all-inclusive inventory of duties, responsibilities and qualifications required. It provides an accurate overview of the work and skills needed to perform this position. Because job content may change from time to time, Encova Insurance reserves the right to add and/or delete functions from this job as it deems necessary for business reasons.</i></div><div></div><div>
Ready to join our team?<br>
At Encova Insurance, we firmly believe that our associates drive our company's success by delivering unrivaled service to our customers. With success in mind, we make an ongoing effort to provide an environment that offers challenging, stimulating, and financially rewarding opportunities. Join us to discover a work experience where you can learn and grow to your fullest potential.</div><div></div><div>
What you can expect from us</div><div>
In addition to a competitive compensation package, we offer a comprehensive benefits package designed to support the well-being and growth of our associates. Available benefits (subject to any policy or plan changes) include, but are not limited to:</div><ul><li><div>
Health, Dental &amp; Vision Insurance</div></li><li><div>
Company-provided life and income protection plans</div></li><li><div>
Eligibility to participate in a company incentive bonus program</div></li><li><div>
401(k) Retirement Plan - 100% company match up to 7% on annual salary</div></li><li><div>
Paid Time Off, Paid Holidays, and Floating Holidays</div></li><li><div>
Flexible Work Arrangements - Hybrid and remote depending on the role</div></li></ul><div></div><div>
We believe that happy, healthy associates are the foundation of great work. Join us and thrive both professionally and personally.</div><div></div><div>
Encova Insurance is an EOE/E-Verify employer.</div><div></div>
#LI-Remote#LI-MF1</div>

Medical Only Claims Specialist, Workers' Compensation

<div>The salary range for this job posting is $108,812.00 - $174,099.00 annually + bonus + benefits. Pay Type: Salary<div></div><div><i>
The above represents the full salary range for this job requisition. Ultimately, in determining your pay and job title, we'll consider your location, education, experience, and other job-related factors, and will fall within the stated range. Your recruiter can share more information about the specific salary range during the hiring process.</i></div><div></div><div><i>
Based upon certain geographical locations, such as Illinois and Pennsylvania, a higher salary range is applicable.</i></div><div></div><div>
This role will manage the Large Midwest claims team and report to a Regional Vice President, Commercial Lines.</div><div></div><div>
Candidates will reside in any of our listed payroll approved states.</div><div></div><div>
Are you a Referral?</div><div>
If you know a current Encova Insurance associate and would like to apply as a referral, please encourage them to submit your referral information before you submit your application. You will receive an email with a direct URL link to the Job Posting of interest. Applying through this URL link will create your referral relationship for our Talent Acquisition Team.</div><div></div><div>
Unique residence requirements are listed in each job posting, please review closely for details.</div><div>
Encova is only able to employ associates who reside and work within specific U.S. states. Our current policies are based on the laws in states in which we are registered for payroll. Our current footprint includes:</div><div>
Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, Wisconsin.</div><div></div><div>
JOB OBJECTIVE:</div><div>
The Director, Workers&rsquo; Compensation Claims is responsible for oversight of the day-to-day performance of the business team claims adjusters, return-to-work specialists, and nurse case managers. In the regional offices, the safety &amp; loss control consultants (SLC) on the business team will also have a dotted line report to this position.</div><div></div><div>
This position&rsquo;s objective is to provide leadership that assures superior, cost-effective service and compliance with adopted best claims practices, and loss control practices if applicable, to eliminate unwarranted loss.</div><div></div><div>
ESSENTIAL FUNCTIONS:<br>
1. Supervise claims management activities for the business team members.<br>
2. Ensure that new policyholders are properly on-boarded. Track these results using Encova systems.<br>
3. Evaluate and assign claims to team adjusters, following proper protocols.<br>
4. Provide guidance to assist with identification of possible complications related to developing injury/exposure claims.<br>
5. Assure establishment of appropriate reserve values throughout the life of the claim. Approve and adjust reserves as necessary.<br>
6. Consult with internal/external medical, legal, and vocational professionals on current and/or recommended treatment, litigation or rehabilitation plans to assist the adjuster in reaching achievable and appropriate claim outcome.<br>
7. Analyze medical, legal and vocational rehabilitation reports compared to established guidelines. Advise staff on findings outside of established guidelines.<br>
8. Supervise and assist business team claims staff with investigation, evaluation and settlement of assigned claims thru application of technical knowledge and human relation skills to effect fair and prompt claim closure and to contribute to a reduced loss ratio.<br>
9. Support and assist claims staff with the investigation and pursuit of subrogation recoveries.<br>
10. Participate in claim discussions at team staffing. Provide guidance when needed.<br>
11. Represent the organization on special projects; carry out speaking engagements for local meetings or conferences.<br>
12. Train and mentor new associates on claims and unit procedures.<br>
13. Work collaboratively with team adjusters, outside counsel, injured employee, employer, health and rehabilitation professionals to manage claim costs, promote quality medical care and timely return-to-work (RTW) to achieve optimum cost-effective medical and vocational outcomes.<br>
14. Perform file reviews for claims staff as part of the Quality Assurance program to assure that claims are being handled in accordance with the company&rsquo;s set best practices.<br>
15. Facilitate meetings with policyholders, both independent of and in concert with the Business Director.<br>
16. Work collaboratively with Claims Operations and the Best Practice Leader on projects involving claim policies, procedures and best practices.<br>
17. Identify, develop, and analyze claims-related reports to assist and advise the Business Director of current and future profitability outcomes.<br>
18. If SLC oversight is part of responsibility, perform periodic ride-alongs with SLC Specialists to ensure proper loss prevention and mitigation is being delivered to Encova customers.<br>
19. If SLC oversight is part of responsibility, participate in SLC performance review conversations with the Business Director.</div><div></div><div>
OTHER FUNCTIONS:<br>
1. Non-essential function: other duties as assigned.</div><div><br>
KNOWLEDGE, SKILLS AND ABILITIES:<br>
<ul><li>Bachelor&rsquo;s degree from an accredited college or university preferred.</li><li>Five years of insurance experience with a private carrier, former workers&rsquo; compensation commission, agency or third-party administrator required.</li><li>Preference may be shown to a candidate with multiple state insurance experience.</li><li>Preference may be shown to a candidate with claims adjusting, case management, or safety and loss control experience.</li><li>Preference may be shown to a candidate with previous managerial experience.</li><li>Must hold or be eligible to obtain an adjuster&rsquo;s license in applicable states.</li><li>Must pass the claims adjuster license exam(s) for applicable states within six months of being hired.</li><li>Demonstrate the ability to motivate people toward a common goal.</li><li>Proven record of providing support as mentor and resource for fellow team members.</li><li>Proven record of effective communication.</li><li>Advanced knowledge of workers compensation insurance practices, statute, precedents and government regulations.</li><li>Understand the implications of both current and future decisions.</li><li>Combine pieces of information to form general rules or conclusions.</li><li>Uses logic and reasoning to identify strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.</li><li>Can translate and explain the meaning of information presented and how that information may be used to effectively make decisions and develop strategies.</li><li>Can evaluate relative costs and benefits of potential actions to choose the best action.</li><li>Can bring parties together to reconcile differences.</li><li>Effectively manages time without direct supervision.</li><li>Use relevant information and expertise to determine whether events or processes comply with laws, regulations or standards.</li><li>Analyze information and evaluates results to choose the best solution.</li><li>Identify complex problems and reviews related information to develop and evaluate options and implement solutions.</li><li>Work effectively in a team environment.</li><li>Able to arrange items or actions in a certain order or pattern according to a specific rule or set of rules.</li><li>Understand how claim costs affect loss ratios, the overall profitability of an account and ultimately, a book of business.</li><li>If SLC oversight is part of responsibility, understand how claim, incident and near miss frequency impacts future loss activity and ultimately the profitability of an account/book of business.</li><li>Ability to work effectively in a paperless environment.</li></ul></div><div><i><br>
This position has been evaluated in accordance with the Americans with Disabilities Act. Encova Insurance makes every effort to reasonably accommodate disabilities to permit performance of the essential functions and candidates who need such accommodation are encouraged to seek it. This description reflects the nature and level of work performed by associates in this position. It is not an all-inclusive inventory of duties, responsibilities and qualifications required. It provides an accurate overview of the work and skills needed to perform this position. Because job content may change from time to time, Encova Insurance reserves the right to add and/or delete functions from this job as it deems necessary for business reasons.</i></div><div></div><div>
Ready to join our team?<br>
At Encova Insurance, we firmly believe that our associates drive our company's success by delivering unrivaled service to our customers. With success in mind, we make an ongoing effort to provide an environment that offers challenging, stimulating, and financially rewarding opportunities. Join us to discover a work experience where you can learn and grow to your fullest potential.</div><div></div><div>
What you can expect from us</div><div>
In addition to a competitive compensation package, we offer a comprehensive benefits package designed to support the well-being and growth of our associates. Available benefits (subject to any policy or plan changes) include, but are not limited to:</div><ul><li><div>
Health, Dental &amp; Vision Insurance</div></li><li><div>
Company-provided life and income protection plans</div></li><li><div>
Eligibility to participate in a company incentive bonus program</div></li><li><div>
401(k) Retirement Plan - 100% company match up to 7% on annual salary</div></li><li><div>
Paid Time Off, Paid Holidays, and Floating Holidays</div></li><li><div>
Flexible Work Arrangements - Hybrid and remote depending on the role</div></li></ul><div></div><div>
We believe that happy, healthy associates are the foundation of great work. Join us and thrive both professionally and personally.</div><div></div><div>
Encova Insurance is an EOE/E-Verify employer.</div><div></div>
#LI-Remote#LI-MF1</div>

Director, Workers' Compensation Claims

Join Encova Insurance and explore 2   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Encova Insurance

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Medical Only Claims Specialist, Workers' Compensation

Director, Workers' Compensation Claims