Senior Claims Analyst

Socket.dev; Egg Harbor Township (NJ); On-site; USD 54,000 - 76,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Health Savings Accounts / FSAs

Life and AD&D Insurance

401(k)

Tuition Reimbursement

Job summary

Enlyte is seeking a dedicated Workers’ Compensation Claims Adjuster to independently investigate, evaluate, and resolve complex claims. You will work with claimants, medical professionals, and employers to ensure timely resolutions and proper benefits.

Coordinate with nurse case managers, establish reserves, and manage diary and potential litigation to achieve favorable outcomes. Responsibilities include enforcing jurisdictional requirements, pursuing subrogation opportunities, and facilitating

Qualifications

• High School diploma required; Associate's or Bachelor's degree preferred, or 3+ years of equivalent work experience in insurance, medical/health or legal related industry.
• Proficient with MS Excel and Word; computer experience with related claims software.
• Excellent verbal and written communication skills; proven interpersonal skills and organizational abilities.
• Experience in Workers’ Compensation and related claims handling practices; knowledge of self-insured retention, excess and reinsurance reporting.

Responsibilities

• Investigate, evaluate, and resolve complex or litigated Workers’ Compensation claims.
• Communicate with claimants, physicians, and employers; manage claims from start to finish.
• Collaborate with nurse case managers for medical management and return-to-work planning.
• Coordinate with employers to facilitate return to work, either full-time or modified duties.
• Establish reserves with rationale; maintain diaries; manage litigation exposure and plans.

Skills

Excel

Word

Claims software

Communication

Interpersonal skills

Organization

Time management

Initiative

Teamwork

Self-insured retention

Reinsurance reporting

Education

High school diploma

Associate/Bachelor preferred

Equivalent experience in insurance/medical/legal

Tools

MS Excel

MS Word

Claims software

Job description

Company Overview

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.

Job Description

Independently 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.
• Manage some claims from the start and also lost time claims and litigated claims.
• Work with both the claimant and a Nurse Case manager 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.
• 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.

Qualifications

Minimum Education:

High School diploma required. Associate’s or Bachelor’s degree preferred, or three or more years of equivalent work experience required in an insurance, medical/health or legal related industry;

Required Skills and Experience

• Proficient with MS Excel and Word
• Computer experience with related claims software
• Excellent verbal and written communication skills
• Proven interpersonal skills with all levels of personnel
• Superior organizational skills
• Customer-focused orientation
• Teamwork and promotes cooperation and commitment within team
• Time management and ability to control time to accomplish goals
• Hard working, diligent, reliable, and has initiativeExperience in Workers’ Compensation and related claims handling practices and ability to apply same
• Deep knowledge of client and carrier claims procedures
• Significant understanding of self-insured retention, excess and reinsurance reporting

Desired Skills and Experience

Completion of Workers’ Compensation training courses internally and/or externally in all significant areas affecting Workers’ Compensation claims handling and practices

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 $53,500 - $75,700 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.

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