Resolution specialist

The salary range for this job posting is $67,466.00 - $107,944.00 annually bonus benefits

The above represents the salary range for this job requisition. Ultimately, in determining your pay, we'll consider your location, education, experience, and other job-related factors.

Your recruiter can share more information about the specific salary range during the hiring process.

Are you a Referral?

If you know a current Encova Insurance associate and would like to apply as a referral, please encourage them to submit your referral information before you submit your application.

You will receive an email with a direct URL link to the Job Posting of interest. Applying through this URL link will create your referral relationship for our Talent Acquisition Team.

Unique residence requirements are listed in each job posting, please review closely for details.

Encova is only able to employ associates who reside and work within specific U.S. states. Our current policies are based on the laws in states in which we are registered for payroll.

Our current footprint includes :

Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, Wisconsin.

This role will work from home any of our licensed payroll states and report to the Director of Injury Claims.

JOB OBJECTIVE :

Investigate, evaluate, negotiate and settle bodily injury claims and any related coverages within established best practices and applicable jurisdictional guidelines.

ESSENTIAL FUNCTIONS :

Handle injury claims including personal and commercial auto, uninsured and underinsured motorists, homeowners' liability , commercial liability and limited litigation files.

Claims may involve serious or permanent injuries including fatalities. Claims may be assigned as first notice, requiring a complete investigation and handling of all aspects of the claim, or may be a reassignment of the injury claim only.

• Review and analyze coverage, apply policy conditions, provisions, exclusions and endorsements and verify applicable limits, deductibles and co-insurance.
• Investigate and gather information, including taking statements as necessary, to determine the facts of loss, liability and subrogation potential.
• Proactively manage and continuously evaluate the claim with specific emphasis on the nature and extent of injury, causality and relatedness of medical treatment received.

Conduct a medical history investigation as necessary.

• Determine and continually evaluate appropriate reserves.
• Establish a plan of action and utilize appropriate resources as necessary to move the file towards resolution.
• Effectively investigate, evaluate, negotiate and settle a minimum average of 20 losses per month. Negotiations will be primarily on the phone, but may occasionally require personal contact.
• Comply with claims organization policies, established best practices and jurisdictional guidelines.
• Complete comprehensive reports and authorization requests as required.
• Maintain competency in the use of multiple claims systems and manage efficient and effective follow-up practices.
• Obtain state licensing as required.
• Serve as a member of claims teams as assigned.

OTHER FUNCTIONS :

1. Maintain an ongoing understanding of claims processes, procedures and systems, and keep current on fair claims practices laws, compliance issues, and business-related developments.

2.Maintain open lines of communications with all stakeholders including resolution specialists that may be involved in the handling of other elements of the file.

3.Attend seminars and workshops as required.

4. Occasional travel may be required.

5.Perform other duties as assigned.

KNOWLEDGE. SKILLS AND EXPERIENCE :

• This position requires considerable experience as a claims resolution specialist or the equivalent experience in the industry or a related field.
• The candidate must have excellent telephone and personal claims negotiations, communication and investigation skills.
• The individual must understand tort law and must have thorough knowledge of medical terms and treatments.
• The candidate must be able to obtain, analyze and evaluate medical history and documentation.
• The candidate must possess detail-oriented organizational skills.
• The candidate must demonstrate a proven ability to evaluate serious and complicated injury claims and to negotiate to a successful conclusion.
• This position requires an excellent knowledge of all personal and commercial lines policies and coverage written by the company.
• This position requires a college degree or equivalent and a strong understanding of insurance and the claims organization.
• Continuing education is strongly preferred and may be obtained through the Institutes (Associate in Claims (AIC) and / or Chartered Property Casualty Underwriter (CPCU) designations) or other accredited insurance education provider.

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.

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 foundations.

Encova Insurance is an EOE / E-Verify employer.

Last updated : 2024-07-22

Salary : $67,466 - $107,944