Injury Resolution Specialist

This role is home-based, but you must reside in one of the following U.S. states where Encova is registered for payroll: 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, or Wisconsin.

About the role

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

Responsibilities

• Handle injury claims including personal and commercial auto, uninsured and underinsured motorists, homeowners’ liability and commercial liability, and limited litigation files. Claims may involve serious or permanent injuries, including fatalities.
• 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.
• Maintain an ongoing understanding of claims processes, procedures and systems, and keep current on fair claims practices laws, compliance issues, and business-related developments.
• Maintain open lines of communications with all stakeholders including resolution specialists that may be involved in the handling of other elements of the file.
• Attend seminars and workshops as required. Occasional travel may be required.
• Perform other duties and special assignments as requested to support business needs.

Requirements

• College degree or equivalent.
• Strong understanding of insurance and the claims organization.
• Continuing education is strongly preferred (e.g., Associate in Claims (AIC) and/or Chartered Property Casualty Underwriter (CPCU) designations).
• Considerable experience as a claims resolution specialist or equivalent experience in the industry or a related field.
• Excellent telephone and personal claims negotiation, communication, and investigation skills.
• Understanding of tort law and thorough knowledge of medical terms and treatments.
• Ability to obtain, analyze, and evaluate medical history and documentation.
• Detail-oriented organizational skills.
• Proven ability to evaluate serious and complicated injury claims and negotiate to a successful conclusion.
• Excellent knowledge of all personal and commercial lines policies and coverage written by the company.

Pay

The salary range for this position is $69,152.00 - $110,642.00 annually, plus bonus and benefits. The final pay and job title will be determined based on location, education, experience, and other job-related factors within the stated range.

Benefits

• Health, Dental & Vision Insurance
• Company-provided life and income protection plans
• Company incentive bonus program
• 401(k) Retirement Plan - 100% company match up to 7% on annual salary
• Paid Time Off, Paid Holidays, and Floating Holidays
• Flexible Work Arrangements - Hybrid and remote depending on the role