Senior Claims Adjuster - Workers' Compensation

The above represents the 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. Your recruiter can share more information about the specific salary range during the hiring process.

The salary range for this job posting for candidates who reside in Illinois is

$58,176 - $116,752 annually + bonus + benefits.

The above represents the salary range for this job requisition in IL. Ultimately, in determining your pay, we'll consider your location, education, experience, and other job-related factors. Your recruiter can share more information about the specific salary range during the hiring process.

This role will work remote from home and ideally reside within the selected states of Illinois or Ohio. However, we will consider candidates who reside anywhere in our payroll approved states with the listed jurisdictional experience.

This position will manage predominantly lost time claims in Illinois, Missouri and Kansas. The position reports to the Director, Workers' Compensation Claims. We may hire at multiple levels depending on the candidate's background and experience and this range is inclusive of both levels.

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 Senior Claims Adjuster manages both routine and complex lost-time claims, including those with the potential to become serious and produce excessive costs. The Senior Claims Adjuster is responsible for the investigation, evaluation and determination of liability for work-related injury and disease claims following established guidelines to determine benefit eligibility. The Senior Claims Adjuster assesses expected losses and creates plans to minimize and/or eliminate risk factors in order to achieve effective claims outcomes. The position's objective is to provide superior service in a cost- effective manner by executing best claim practices to eliminate unwarranted losses. The Senior Claims Adjuster also serves as a resource to Claims Adjusters.

ESSENTIAL FUNCTIONS:
1. Methodically 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. Gathers facts by conducting interviews with all involved parties and considers all the elements of the claim prior to issuing a decision.
3. Take recorded statements when necessary.
4. Decides the outcome of the claim using sound judgment by applying established policy, procedures, regulations and guidelines.
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. Establishes and maintains reserve values within authority limits, which accurately predict the loss reflecting the current known circumstances of the claim.
7. Actively develops the investigation of and pursuit of subrogation recoveries when possible.
8. Consults with supervisor or technical support staff on unusually complex claims.
9. Investigates, evaluates and negotiates settlements, applying technical knowledge and human relation skills to effect fair and prompt claim closure and to contribute to a reduced loss ratio.
10. Redirects the claim to the appropriate subject matter expert if the claim becomes significantly complex or presents significantly increasing financial exposure.
11. Applies effective protocols for medical management, litigation, fraud/abuse and recovery.
12. Effectively manages litigation in conjunction with legal counsel.
13. Presents claims and participates in discussion at team staffing.
14. Works collaboratively with injured employee, employer, outside counsel, health and rehabilitation professionals to manage the claims costs, promote quality medical care and timely return-to-work to achieve optimal cost-effective medical and vocational outcomes.
15. Along with the supervisor, Business Director and other claims staff, assists with or facilitates meetings with policyholders.
16. Nonessential function: other duties as assigned.

OTHER FUNCTIONS:
1. Knowledge in best claims practices and laws, court procedures, precedents and government regulations.
2. Ability to apply relevant information and individual judgment to determine whether events or processes comply with laws, regulations or standards.
3. Ability to recognize and analyze new or changing information that could affect the claims handling strategy and/or potential claims cost, and effectively use the information to manage the claim.
4. Demonstrated ability to work effectively in a team environment.
5. Demonstrated ability to use logic and sound reasoning to identify alternative solutions for problem-solving.
6. Demonstrated understanding of how to apply general rules to specific problems to produce workable solutions.
7. Ability to develop specific goals and plans to prioritize, organize, and accomplish work.
8. Demonstrated proficiency in evaluating the relative costs and benefits of potential actions to choose the most appropriate one.
9. Skilled in the use of computers and claims management systems and other typical business-related programs.
10. Demonstrated ability to develop and maintain strong, effective internal and external relationships.
11. Ability to work effectively in a paperless environment.

KNOWLEDGE, SKILLS AND ABILITIES:
* Bachelor's Degree from an accredited college or university is preferred.
* Must have three years of experience in the insurance, claims investigation, legal, rehabilitation, or medical claims processing. Workers' compensation claims experience preferred.
* Must hold or be eligible to obtain a valid Adjuster's License in applicable states. Must pass the claims adjuster license exam(s)for applicable states where Encova conducts business within 60 days of being hired.
* Must display skills and experience in industry's best practices commensurate with Encova's published Best Practices for Claims Management.

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 your diverse ideas will be met with enthusiasm - where you can learn and grow to your fullest potential.

What you can expect from us
Join our family of industry leaders, and let us reward you with a competitive salary, bonus and benefits package that includes but is not limited to: a 401(k), wellness programs, bonus incentive plans and flexible schedules, with an early close of the office every Friday. Additionally, Encova aspires to be an outstanding corporate citizen in all the markets we serve; we encourage and support associate participation in community initiatives through our foundations.

Encova Insurance is an EOE/E-Verify employer.