Qureos Mentor

Encova Insurance

<div>The salary range for this job posting is $55,132.00 - $110,642.00 annually + bonus + benefits. Pay Type: Salary
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.
We would prefer candidates who reside in Pennsylvania or West Virginia however, will consider those who reside in any of our listed payroll approved states with the related experience.
This role will manage Workers' Compensation Lost Time and Medical Only claims within multiple jurisdictions. However, ideal candidates will have experience managing Workers' Compensation lost time claims in Pennsylvania and/or West Virginia and Maryland.
We may hire a senior level depending on the candidate's background and experience and the salary range is inclusive of all levels. The position reports to a Director, Workers' Compensation Claims.
Are you a Referral?
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.
Unique residence requirements are listed in each job posting, please review closely for details.
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:
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.
JOB OBJECTIVE:
The Lost Time Claims Specialist, Workers&rsquo; Compensation primarily manages indemnity claims. The Lost Time 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 Lost Time Claims Specialist also serves as a resource to Medical Only Claims Specialists and Claims Specialist Trainees. 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.
ESSENTIAL FUNCTIONS: 
1. Evaluates and establishes an action plan to manage medical and indemnity benefits associated with injury and occupational disease claims to their most cost- effective conclusion. 
2. Decides the outcome of the claim using sound judgment by applying established policy, procedures, regulations and guidelines. 
3. Gathers facts by conducting interviews with all involved parties and considers all the elements of the claim prior to issuing a decision. 
4. Take recorded statements when necessary. 
5. Determines eligibility of indemnity and medical benefits once salary information and medical treatment plans have been secured and processed within the designated authority levels. 
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. 
7. Actively identifies and develops the investigation of and pursuit of subrogation recoveries when possible. 
8. Consults with assigned claim director, return to work specialists, nurse case managers, internal/external medical, and legal on current and/or recommended treatment, litigation or rehabilitation plans to ensure claims outcomes are achievable and appropriate. 
9. Works collaboratively with the injured worker, employer, outside counsel, and health and rehabilitation professionals to manage the claims costs and promote quality medical care. 
10. Works collaboratively with the injured worker, employer, assigned return to work specialist, and medical providers to facilitate the injured worker&rsquo;s safe and timely return to work. 
11. Manages claims litigation, including expenses, by collaborating and providing direction to panel counsel throughout the life of the claim. 
12. Analyzes reports from external resources such as physicians, attorneys, and/or vocational rehabilitation experts to evaluate and adjust claim strategies as needed.
 
13. Evaluates and negotiates claim settlements utilizing human relation skills and technical knowledge to achieve the best possible outcome. 
14. Presents and summarizes claim details at internal team staffing, participates in discussions, and provides guidance as needed. 
15. Consults with assigned claim director if the loss becomes significantly complex or presents significantly increasing financial exposure. 
16. Follows established claims best practices related to medical management, litigation, fraud/abuse and recovery. 
17. Effectively and independently uses available resources to prioritize, organize, and complete work in a timely manner to meet jurisdictional requirements, timeframes, and internal metrics. 
18. Develops presentations for special projects such as internal/external meetings and conferences as needed. 
19. Along with the claim director, regional vice president and other claims staff, participates in claim reviews, onboardings, etc. for our policyholders and agents. 
20. Proactively collaborate with our policyholders to ensure alignment of objectives and foster continuous improvement.
OTHER FUNCTIONS: 
1. Nonessential function: other duties as assigned.<div> 
KNOWLEDGE, SKILLS AND ABILITIES: 
<ul><li>Bachelor&rsquo;s Degree from an accredited college or university is preferred.</li><li>Three years of experience in the field of workers&rsquo; compensation insurance required.</li><li>Ability to manage claims through the litigation process.</li><li>Internal candidates must demonstrate knowledge of Encova Best Practices guidelines and meet quality standards.</li><li>One valid workers&rsquo; compensation adjuster license is strongly preferred. Must be eligible to obtain additional licenses as required.</li><li>Must pass the claims adjuster license exam(s) as assigned within 90 days of being hired.</li><li>Preference may be shown to candidates with multiple state claims management experience.</li><li>Experience in workers&rsquo; compensation claims practices and laws, court procedures, precedents and state statutes.</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 multitasks 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>
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.
Ready to join our team? 
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.
What you can expect from us
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:<ul><li>
Health, Dental &amp; Vision Insurance</li><li>
Company-provided life and income protection plans</li><li>
Eligibility to participate in a company incentive bonus program</li><li>
401(k) Retirement Plan - 100% company match up to 7% on annual salary</li><li>
Paid Time Off, Paid Holidays, and Floating Holidays</li><li>
Flexible Work Arrangements - Hybrid and remote depending on the role</li></ul>
We believe that happy, healthy associates are the foundation of great work. Join us and thrive both professionally and personally.
Encova Insurance is an EOE/E-Verify employer.
#LI-Remote#LI-MF1</div>

Lost Time Claims Specialist - Workers' Compensation

<div>The salary range for this job posting is $86,744.00 - $138,790.00 annually + bonus + benefits. Pay Type: Salary
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.<div>
Encova Insurance is seeking a Senior Commercial Lines Strategy Manager to drive profitable growth across our commercial lines portfolio. In this role, you will leverage data, market insights, and innovative practices to enhance underwriting performance and deliver a strong customer experience.
This Columbus, Ohio&ndash;based position follows a hybrid schedule, with regular in-office days each week, and requires candidates to reside locally.</div>
Are you a Referral?
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.
Unique residence requirements are listed in each job posting, please review closely for details.
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:
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.
JOB OBJECTIVE:
This role supports the development and implementation of the commercial lines underwriting growth and profitability strategies and underwriting guidelines and controls. This role is responsible for the design and development of underwriting practices that ensure the proper matching of risk with rate using advanced technology and efficient processes to create a platform viewed as easy to use by our customers. The ability to extract and analyze data of the commercial lines portfolio to determine profit and loss drivers and identify growth and profit opportunities is critical.
Additionally, this role analyzes product portfolio to create recommendations for book management, underwriting strategy and underwriting guidelines that support profitable growth. This position analyzes and evaluates various analytics tools aimed at reducing loss costs, improving efficiency and reducing underwriting expenses to achieve profitable underwriting results.
The role is charged with helping improve the quality and efficiency of the underwriting operation and supports developing technical competencies and best practices. The role works closely with other functional areas in the Company to analyze drivers of growth and profit and develops implementation plans.
ESSENTIAL FUNCTIONS:<ul><li>
Support profitable growth and expansion of the commercial lines portfolio, through the design and development of profitability initiatives, pricing strategies, best practices, quality assurance programs, and business workflow improvement.</li><li>
Gather information on competitive and producer trends, and external market intelligence, including legal, economic, demographic, and distribution trends to build recommendations.</li><li>
Analyze opportunities for improvement in underwriting guidelines and business processes.</li><li>
Develop and maintain tools to improve agency analysis capabilities, individual risk underwriting, and the aggregate portfolio performance.</li><li>
Assist in the development of business requirements with business analysts to create functional system design.</li><li>
Present to and train internal and external stakeholders on product and service introductions, enhancements and the associated processes based on a solid understanding of and impact to field stakeholders such as agents, underwriting, customer service, marketing and policyholders. Develops appropriate supporting materials.</li><li>
Create, distribute, and maintain effective resources, education materials, and documentation of underwriting processes or procedures.</li><li>
Develop guidelines, policies and procedures that address identified business needs and support the achievement of business results. Determine system impacts as a result of process introductions or changes.</li><li>
Develop and maintain strategic and tactical product and service development initiatives using trend monitoring, feedback from stakeholders and marketplace competitor review. Develop and provide monitoring of the lines of business and industry segments and alerting the industry strategy, product, and business teams of trends observed, areas of profitability, and items needing further attention.</li><li>
Provide subject matter expertise support for system changes needed for state-specific requirements and companywide initiatives.</li><li>
Provide subject matter expertise on system integration of third-party vendor products including the evaluation, recommended uses and training of underwriting associates.</li><li>
Facilitate testing and analysis of results of system upgrades.</li><li>
Develop and facilitate training for PolicyCenter/CoreSuite fundamentals, workflow procedures and new system processes.</li><li>
Analyzes various third-party vendor products designed to improve profitability and efficiency.</li><li>
Manage commercial lines vendor billing processes and budgeting.</li><li>
Establish excellent working relationships with business partners and leadership to ensure they are confident in requesting assistance from the Underwriting Office.</li><li>
Provide exceptional customer service to underwriting teams and the Underwriting Office through trust and responsiveness.</li><li>
Survey business units on behalf of the Underwriting Office teams to provide input and a voice into Underwriting Office decisions/activities.</li><li>
Actively lead and participate in all aspects of effective quality control assessments. These may include conducting new and renewal account audits, monitoring, process quality assurance, assessing key performance indicators, large loss analysis, action plans, etc.</li><li>
Support both internal and external audit efforts.</li><li>
Lead and manage key project teams, as assigned.</li></ul>
OTHER FUNCTIONS:<ul><li>
Represent Underwriting in meetings as necessary.</li><li>
Develop in-depth knowledge of commercial lines vendors and potential opportunities to build new relationships as needed.</li><li>
Write detailed proposals.</li><li>
Analyze, design and develop underwriting programs to improve the customer experience.</li><li>
Perform other duties and projects as assigned.</li></ul>
KNOWLEDGE, SKILLS AND ABILITIES:<ul><li>
A bachelor&rsquo;s degree from an accredited college or university is preferred. Commensurate experience may be considered.</li><li>
Minimum of seven years of commercial lines experience or comparable experience in the U.S. Property &amp; Casualty industry in areas such as analytics, actuarial science, etc. preferred.</li><li>
Chartered Property Casualty Underwriter (CPCU) or other industry designations preferred.</li><li>
General knowledge of insurance industry, practices, standards, and concepts within related operations and field work.</li><li>
Demonstrated analytical skills including expertise in a variety of qualitative and quantitative techniques and data analytics approaches.</li><li>
Strong analytic capabilities and experience using data to solve critical business cases.</li><li>
An understanding and prior experience integrating predictive analytics into underwriting appetite and rate determination.</li><li>
Demonstrated initiative, autonomy, commitment to innovation and process improvements and the ability to think strategically, balanced with practical day-to-day execution.</li><li>
Excellent communication (verbal and written) and interpersonal skills, with the ability to effectively convey information and provide feedback to individuals at all levels of the organization.</li><li>
Problem-solving abilities and presentation skills.</li><li>
Demonstrated expertise and success leading projects and project teams.</li><li>
Working knowledge of technology applications and support business functions.</li><li>
Strong customer service, networking and relationship skills.</li><li>
Must be pro-active, driven and take initiative.</li><li>
Ability to work independently with minimal guidance as well as collaboratively in a team environment.</li></ul>
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.
Ready to join our team? 
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.
What you can expect from us
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:<ul><li>
Health, Dental &amp; Vision Insurance</li><li>
Company-provided life and income protection plans</li><li>
Eligibility to participate in a company incentive bonus program</li><li>
401(k) Retirement Plan - 100% company match up to 7% on annual salary</li><li>
Paid Time Off, Paid Holidays, and Floating Holidays</li><li>
Flexible Work Arrangements - Hybrid and remote depending on the role</li></ul>
We believe that happy, healthy associates are the foundation of great work. Join us and thrive both professionally and personally.
Encova Insurance is an EOE/E-Verify employer.
#LI-Hybrid#LI-LP1</div>

Senior Commercial Lines Strategy Manager

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

About Company

Lost Time Claims Specialist - Workers' Compensation

Senior Commercial Lines Strategy Manager