This position supports our workers' compensation line of business, Eastern Alliance. This is a hybrid position, reporting to our Lancaster PA (preferred) or Wexford PA office locations approximately 2 days per month.
Depending upon candidate qualifications, we may fill this position at a different level.
The primary responsibility of this position is to consistently execute the Company’s ecovery® Return to Wellness philosophy and business model that leads to better outcomes for our injured workers and insureds. Responsibilities of this position include managing all aspects of assigned claims, including verifying coverage, investigating, managing, and resolving workers’ compensation claims (medical only and lost time) for the Company’s customers under direct supervision, following established Company requirements and procedures, and promptly establishing and maintaining accurate reserves with an authority limit of up to $50,000 all in support of the Company’s revenue and profitability objectives and overall business plan.
What you'll do:
- 45% - Complete ongoing claim management activities proactively and with a sense of urgency in accordance with the ecovery® Return to Wellness philosophy to execute the established plan of action and achieve favorable outcomes for all parties. Maintain, cultivate, and develop high quality, collaborative working relationships with all parties, including injured workers, agents, customers, and co-workers. Maintain regular contact by telephone and correspondence with all parties. Seek complete information necessary to manage claims and achieve favorable outcomes. Respond to inquiries in a timely, courteous, and professional manner.
- 30% - Promptly investigate all assigned claims to establish trust and rapport with all parties, accurately assess coverage, determine the nature and extent of the injuries sustained, and reinforce Return to Wellness expectations. Make fair and timely determinations of compensability. Demonstrate empathy, professionalism, integrity, and objectivity at all times. Prepare reports and forms as required by jurisdictional regulations and by the Company’s established procedures. Promptly establish and maintain case reserves that accurately reflect the anticipated financial exposure on each claim; revise reserves promptly based on changes in facts and circumstances. Identify subrogation potential.
- 15% - Manage Return to Wellness initiatives by working collaboratively with agents, clients, risk managers and underwriters to ensure proper return to work guidelines and procedures are established, followed and achieved.
- 5% - Attend business unit, department and company meetings.
- 5% - Assist with Company projects as assigned and continue professional growth and development through the attendance and participation in insurance related events/ functions, seminars, classes and conferences.
What we're looking for:
- Bachelor’s degree is preferred; a HS Diploma/GED with a minimum eight years of experience working in a medical, legal or insurance environment can replace the bachelor’s degree requirement.
- Basic knowledge of medical terminology, common medical procedures and treatments is required.
- Some knowledge of applicable state laws and industry standards is required.
- Proficiency in Microsoft Office computer applications, including Word and Excel, and ability to learn new computer software applications.
- Attention to detail in processing all information, establishing priorities and meeting deadlines.
- Ability to handle multiple priorities simultaneously.
- Excellent organization and time management skills.
- Excellent analytical and problem-solving skills, including analyzing and interpreting large amounts of information and formulating logical, objective conclusions based upon the facts.
- Ability to assess the urgency and importance of a situation and take appropriate action.
- Empathic listener with the ability to listen and respond to another person in a way that engenders mutual understanding and trust.
- Ability to communicate effectively and professionally both verbally and in writing with various constituencies and at all levels, both in and outside of the organization, including agency partners, customers, injured workers and providers.
- Ability to maintain confidential information.
- Ability to operate standard office equipment including, but not limited to copiers, printers, etc.
- Ability to attend insurance and industry/business functions to promote and present a positive image of the Company.
#LI-Hybrid
We are committed to providing a dynamic and inclusive environment where everyone can do their best work and grow personally and professionally.
For that reason, we partner with The Predictive Index (PI) – an organization equally committed to improving the working lives of people, to help us hire the best talent by providing additional insight about one’s work style.
The position you applied to requires completion of two assessments prior to being scheduled to interview with a hiring manager. A Talent Acquisition team member may review your application and contact you before the assessment is complete. These assessments are Behavioral and Cognitive, and each assessment takes less than 12 minutes to complete.
After submitting your application, you will receive two emails from The Predictive Index inviting you to complete each of these assessments (please check your SPAM or Junk email folder if you do not see these emails in your inbox).
Note: If you already completed the assessments as part of an application with us, we may have results on file and you may not receive the emails inviting you to take the assessments. If you are moving forward in the process, a Talent Acquisition team member will confirm if we already have your assessment results.
$57,575.00 - $95,008.00
