Senior Claims Analyst

About the role

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.

Responsibilities

• Evaluate claimant eligibility;
• Communicate with attending physician, employer and injured worker;
• Manage high exposure, complex and catastrophic claims;
• Work with both the claimant and their physician to medically manage the claim, from initial medical treatment to reviewing and evaluating ongoing treatment and related information;
• 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;
• Closely manage 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 five 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 initiative; Expertise in Workers’ Compensation and related claims handling practices and ability to apply same; 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 $53,000 - $77,000 annually, and will be based on a number of additional factors including skills, experience, and education.

Pay

The expected base pay for this position ranges from $53,000 - $77,000 annually, and will be based on a number of additional factors including skills, experience, and education.

Schedule

Remote work is available.

Skills

Expertise in Workers’ Compensation and related claims handling practices and ability to apply same; Significant understanding of self-insured retention, excess and reinsurance reporting.

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.

Company

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.