Senior Claims Analyst 3 Workers Compensation - Coventry WCS

Company Overview:

The Enlyte Family of Businesses

Mitchell | Genex | Coventry

 

Enlyte is the parent brand of Mitchell, Genex and Coventry, an organization unlike any other in the Property & Casualty industry, bringing together three great businesses with a shared vision of using technology innovation, clinical services and network solutions to help our customers and the people they serve. Our suite of products and services enable our employees to help people recover from challenging life events, while providing opportunities for meaningful impact and career growth.

Job Description:

Senior Claims Analyst 3 Workers Compensation investigates, evaluates, disposes of and settles claims with minimal supervision, including the investigation, determination and evaluation of coverage, compensability/liability and damages, and the setting of proper reserves in accordance with legal statutes, policy provisions and company guidelines.

 

Perks: Full and comprehensive benefits programs starting on your first day, 24 days of paid vacation/holidays in your first year plus sick days, Employee Assistance and a Referral Program.

 

 

Responsibilities include

• The Specialist is expected to act as a Senior Claims Adjuster Specialist carrying a reduced workers compensation pending while also performing supervisory functions.
• Assistant Supervisor is expected to plan, direct, and guide the activities of adjusters.
• The Senior Claims Analyst 3 is expected to assist Supervisor with tasks as assigned which could include Supervision of files, performing monthly SCORE audits, Internal claim reviews, performing 1:1 performance meeting with staff, New claim set up and documentation, Review and approve reserves, Training, Attend client meetings.
• Specialist will meet with the Supervisor regularly to discuss any concerns or issues.
• Specialist may assist in hiring and training of new employees.
• Understand concepts of compensability and casual relationship to move claims toward resolution using Best Practices.
• Promptly investigate all assigned claims for whether work related.  
• Investigate claims by interviewing claimants and witnesses, establish claim reserves, handle evidence, obtain evidence, obtain and interpret official reports, medical reports and claim forms, and attend/participate at mediation, trials or hearings.
• Negotiate and settle claims, set reserves and manage litigation within client service parameters and authority levels by obtaining demands and making offers to claimants.
• Attending client meetings and present PARs.
• Document plan of action in the claim system and set appropriate diaries.
• Manage diary and complete tasks to ensure that cases move to the best financial outcome and timely resolution.
• Close all files as appropriate in a timely and complete manner.
• Maintain closing ratio as directed by management team.
• Attend/participate in mediation, trials, or hearings.
• Routinely interact with clients, claimants, attorneys, investigators, experts, and other vendors.

Qualifications:

Minimum Education:  Associate or bachelor’s degree

 

Required Skills and experience:

• At least 5-6 years of experience handling liability claims required.
• MS Excel and Word; computer experience with related claims software; 
• Excellent verbal and written communication skills;
• Proven interpersonal skills capable of dealing with all levels of personnel.
• Ability to multitask; excellent negotiation skills.
• Superior organizational and decision making skills.
• Customer-focused 
• Strong analytical and strategizing skills; 
• Significant understanding of self-insured retention, excess and reinsurance reporting; fluent in medical terminology and medical/injury treatments. 

 

Benefits:We’re committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. Benefits eligibility may differ depending on full-time or part-time status. Compensation depends on the applicable US geographic market. The expected base pay for this position ranges from $59,235 - $80,000 annually, and will be based on a number of additional factors including skills, experience, and education. The Company is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability. Don’t meet every single requirement? Studies have shown that women and underrepresented minorities are less likely to apply to jobs unless they meet every single qualification. We are dedicated to building a diverse, inclusive, and authentic workplace, so if you’re excited about this role but your past experience doesn’t align perfectly with every qualification in the job description, we encourage you to apply anyway. You may be just the right candidate for this or other roles.