Senior Claims Analyst

Enlyte•Egg Harbor Township, NJ

9h•Remote

About The Position

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. The Opportunity Investigates, evaluates, disposes of and settles the most complex and highest exposure claims with minimal supervision, including the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves in accordance with legal statutes, policy provisions and company guidelines. Specialist is expected to act as a Senior Claims Adjuster Specialist carrying a reduced pending while also performing supervisory functions. •Assistant Supervisor is expected to plan, direct and guide the activities of adjusters •Specialist is expected to assist Supervisor with tasks as assigned which could include; Supervision of files, Performing monthly SCORE audits, Internal claim reviews, Performing1:1 performance meetings 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 coverage, policy interpretation, exposure recognition and liability determination to analyze and move claims toward resolution using Best Practices. •Promptly investigate all assigned claims for coverage, liability assessment and damages. •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. •Attend 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 at mediation, trials or hearings. •Routinely interact with clients, claimants, attorneys, investigators, experts and other vendors. •Perform other duties as required.

Requirements

Associates or Bachelor’s degree, or five or more years of equivalent work experience required in an insurance/TPA or related industry
At least 5-6 years of experience handling workers' compensation claims required; more experience may be required depending upon complexity of claim pending.
Completion of training courses internally and/or externally in all significant areas affecting claims handling and practices.
Proficient with MS Excel, Word and related claims software
Excellent verbal, written communication and interpersonal skills
Exceptional multi-tasking, organizational and decision-making abilities
Strong negotiation, analytical and strategic thinking skills
Customer-focused with expertise in tort claims handling practices
Deep knowledge of client/carrier claims procedures and self-insured retention
Understanding of excess/reinsurance reporting requirements
Fluent in medical terminology and medical/injury treatments

Responsibilities

Investigates, evaluates, disposes of and settles the most complex and highest exposure claims with minimal supervision, including the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves in accordance with legal statutes, policy provisions and company guidelines.
Act as a Senior Claims Adjuster Specialist carrying a reduced pending while also performing supervisory functions.
Plan, direct and guide the activities of adjusters.
Assist Supervisor with tasks as assigned which could include; Supervision of files, Performing monthly SCORE audits, Internal claim reviews, Performing 1:1 performance meetings with staff, New claim set up and documentation, Review and approve reserves, Training, Attend client meetings.
Meet with the Supervisor regularly to discuss any concerns or issues.
Assist in hiring and training of new employees.
Understand concepts of coverage, policy interpretation, exposure recognition and liability determination to analyze and move claims toward resolution using Best Practices.
Promptly investigate all assigned claims for coverage, liability assessment and damages.
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.
Attend 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 at mediation, trials or hearings.
Routinely interact with clients, claimants, attorneys, investigators, experts and other vendors.
Perform other duties as required.