Worker Compensation Claims Adjuster 2

Enlyte•Egg Harbor Township, NJ

57d•$21 - $24•Remote

About The Position

At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth. Be part of a team that makes a real difference. This is a full-time remote position that can be located anywhere in the U.S. Must be able to work EST timezone Investigates, evaluates, and resolves assigned Workers' Compensation claims of a more complex or litigated nature in a timely manner in accordance with legal statutes, policy provisions, and company guidelines. Evaluate claimant eligibility; communicate with attending physician, employer and injured worker. Work with both the claimant and their physician to medically manage the claim, from initial medical treatment to reviewing and evaluating ongoing treatment and related information. Work directly with employers to facilitate a return to work, either on a full-time or modified duty basis. Confirm coverage and applicable insurance policy or coverage document and statutory requirements. Identify potential for third party recovery, including subrogation, Second Injury Fund or other fund involvement (when applicable) and excess or reinsurance reimbursement. Pursue the process of reimbursement and complete posting of recovery to the claim file, where appropriate. Identify potential for disability or pension credits or offsets and apply same where appropriate. Ensure timely denial or payment of benefits in accordance with jurisdictional requirements. Establish claim reserve levels by estimating the potential exposure of each assigned claim, establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure. Establish compensability status through case investigation and evaluation and application of jurisdictional statutes and laws. Manage diary in accordance with Best Practices and complete tasks to ensure that cases move to the best financial outcome and timely resolution. Where litigation is filed, evaluate exposure and work with defense counsel to establish strong defenses, prepare litigation plan of action, set legal reserve and manage litigation over life of claim. Close all files as appropriate in a timely and complete manner. Maintain closing ratio as directed by management team. Oversee and coordinate medical treatment for injured employees and provide information to treating physicians regarding employees' medical history, health issues, and job requirements; provide direction to assigned nurse case manager where applicable. Complete PARs (payment authorization request) when applicable. Comply with all excess and reinsurance reporting requirements; manage self-insured retention reporting.

Requirements

High School diploma required.
2 years of experience handling workers' compensation claims.
Completion of Workers' Compensation training courses internally and/or externally in all significant areas affecting Workers' Compensation claims handling and practices.

Nice To Haves

Associate's or Bachelor's degree preferred.
Workers' Compensation licenses, certifications, awards preferred.

Responsibilities

Investigates, evaluates, and resolves assigned Workers' Compensation claims of a more complex or litigated nature in a timely manner in accordance with legal statutes, policy provisions, and company guidelines.
Evaluate claimant eligibility; communicate with attending physician, employer and injured worker.
Work with both the claimant and their physician to medically manage the claim, from initial medical treatment to reviewing and evaluating ongoing treatment and related information.
Work directly with employers to facilitate a return to work, either on a full-time or modified duty basis.
Confirm coverage and applicable insurance policy or coverage document and statutory requirements.
Identify potential for third party recovery, including subrogation, Second Injury Fund or other fund involvement (when applicable) and excess or reinsurance reimbursement. Pursue the process of reimbursement and complete posting of recovery to the claim file, where appropriate.
Identify potential for disability or pension credits or offsets and apply same where appropriate.
Ensure timely denial or payment of benefits in accordance with jurisdictional requirements.
Establish claim reserve levels by estimating the potential exposure of each assigned claim, establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure.
Establish compensability status through case investigation and evaluation and application of jurisdictional statutes and laws.
Manage diary in accordance with Best Practices and complete tasks to ensure that cases move to the best financial outcome and timely resolution.
Where litigation is filed, evaluate exposure and work with defense counsel to establish strong defenses, prepare litigation plan of action, set legal reserve and manage litigation over life of claim.
Close all files as appropriate in a timely and complete manner.
Maintain closing ratio as directed by management team.
Oversee and coordinate medical treatment for injured employees and provide information to treating physicians regarding employees' medical history, health issues, and job requirements; provide direction to assigned nurse case manager where applicable.
Complete PARs (payment authorization request) when applicable.
Comply with all excess and reinsurance reporting requirements; manage self-insured retention reporting.