Claims Adjuster - Hybrid role
Company: Encova Insurance
Posted on: November 23, 2022
We have two openings for this role. The positions will work
predominately in the Charleston, WV office and upon training being
completed will work on average three days per week from home. The
role will report to a Director, Workers' Compensation Claims on the
West Virginia Large Accounts team. Workers' Compensation claims
handling experience in WV is strongly preferred. Experience in any
of the following jurisdictions is a plus; VA, MD, PA or KY.We will
consider hiring a senior level adjuster based upon experience and
qualifications. JOB OBJECTIVE:
The Claims Adjuster manages both medical only and lost-time claims,
including those with the potential to become serious and produce
excessive costs. The 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 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.ESSENTIAL FUNCTIONS:
1. Methodically evaluates and establishes an action plan to manage
medical and indemnity benefits associated with medical only and
routine lost-time 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
3. Decides the outcome of claims using sound judgment and applying
established policy, procedures, regulations and guidelines.
4. Determines eligibility of indemnity and medical benefits once
salary information and medical treatment plans have been secured
and processed within the designated authority levels.
5. Actively investigates and pursues subrogation recoveries when
6. Establishes and maintains reserve values, within authority
limits, which accurately predict the losses reflecting the current
known circumstances of the claim.
7. Consults with more experienced adjuster, supervisor or technical
support staff as needed.
8. Investigates, evaluates, and negotiates settlements by applying
technical knowledge and human relation skills to effect fair and
prompt claim closure and to contribute to a reduced loss ratio.
9. Redirects the file to the appropriate subject matter expert if
the claim becomes more complex or presents increasing financial
10. Applies effective protocols for medical management, litigation,
fraud/abuse and recovery.
11. Presents claims and participates in discussion at team
12. 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
13. Along with the supervisor, Business Director and/or more
experienced adjusters, assists in facilitating meetings with
1. Nonessential function: other duties as assigned.
KNOWLEDGE, SKILLS AND ABILITIES:
* Bachelor's Degree from an accredited college or university is
* Must have one year experience in the field of 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
* Must pass the claims adjuster license exam(s) for applicable
states within 6 months of being hired.
* Familiar with best claims practices and applicable laws, court
procedures, precedents and government regulations.
* Ability to use relevant information and individual judgment to
determine whether events or processes comply with laws, regulations
* Basic 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.
* Ability to work effectively in a team environment.
* Ability to use logic and sound reasoning to identify alternative
solutions for problem-solving.
* Basic understanding of how to apply general rules to specific
problems to produce workable solutions.
* Ability to create and execute specific goals and plans to
prioritize, organize, and accomplish work.
* Basic understanding of how to evaluate the relative costs and
benefits of potential actions to choose the most appropriate
* Skilled in the use of office computers and other typical
* Ability to develop and maintain constructive and cooperative
internal and external relationships.
* Ability to work effectively in a paperless environment.
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
Encova Insurance is an EOE/E-Verify employer.
Keywords: Encova Insurance, Charleston , Claims Adjuster - Hybrid role, Other , Charleston, West Virginia
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