This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The WC Disability Claims Specialist manages within company best practices workers’ compensation claims to best possible outcome, supporting the goals of claims department and of CorVel. Manages the claims toward closure and are looking for settlement opportunities throughout their reviews. This role is available for onsite, remote and hybrid work arrangements. - Receives claims, confirms policy coverage and acknowledgement of the claim - Review for validity and compensability of the claim - Reviews and revises reserve and authorizes payments within reserving authority limits - Ensures timely and accurate payment of WC claim benefits including indemnity and medical - Initiates investigations, including alive and well checks, when necessary, to confirm continued payment of benefits - Manages workers’ compensation claims toward closure (targeted case load is 250 – 300 files) - Develops strategies and pursues settlement and/or claim closures, whenever possible - Communicates claim status with the customer, claimant and client - Adheres to client and carrier guidelines and participates in claim reviews, as needed - Additional projects and duties as assigned Qualifications - State Certification as an Experienced Examiner - Bachelor’s degree or a combination of education and related experience - Minimum of 1 year of industry experience and claims management preferred - Preference for previous experience in WC disability benefit management Requirements - Excellent written and verbal communication skills - Ability to learn rapidly to develop knowledge and understanding of claims practice - Analytical thinking: identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making - Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets - Strong interpersonal, time management and organizational skills - Ability to meet or exceed performance competencies - Ability to work both independently and within a team environment Benefits - A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. Pay Range CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $48,143 - $71,852

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Claim Examiner - Liability (REMOTE) Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands? - Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. - Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations. - Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. - Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights. - Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. - Enjoy flexibility and autonomy in your daily work, your location, and your career path. - Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. PRIMARY PURPOSE: To analyze mid- and higher-level general liability claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.. ESSENTIAL FUNCTIONS and RESPONSIBILITIES - Manages mid-level general liability claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level. - Assesses liability and resolves claims within evaluation. - Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract. - Manages subrogation of claims and negotiates settlements. - Communicates claim action with claimant and client. - Ensures claim files are properly documented and claims coding is correct. - May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review. - Maintains professional client relationships. ADDITIONAL FUNCTIONS and RESPONSIBILITIES - Performs other duties as assigned. - Supports the organization's quality program(s). - Travels as required. QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university preferred. Experience: 4 years of Liability claims management experience or equivalent combination of education and experience required. TAKING CARE OF YOU - Flexible work schedule. - Referral incentive program. - Career development and promotional growth opportunities. - A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

The salary range for this job posting is $49,225.00 - $78,759.00 annually + bonus + benefits. Pay Type: Salary The above represents the full salary range for this job requisition. Ultimately, in determining your pay and job title, we'll consider your location, education, experience, and other job-related factors, and will fall within the stated range. Your recruiter can share more information about the specific salary range during the hiring process. The actual salary range for candidates who reside in Pennsylvania is $53,241 - $85,186 annually + bonus + benefits. Pay Type: Salary While we may prefer candidates who can work remote in Pennsylvania, we will consider those who live in any of our listed payroll approved states. Ideal candidates will have Workers' Compensation claims handling experience in Pennsylvania. Maryland, Delaware, DC or New Jersey workers compensation claims handling would be a plus. The position reports to the Director, Workers' Compensation Claims. 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. JOB OBJECTIVE: The Medical Only Claims Specialist, Workers’ Compensation manages a high frequency desk, which includes primarily medical only claims. The Medical Only Claims Specialist is responsible for the investigation, evaluation, and determination of compensability for work-related injury and disease claims following established guidelines to determine benefit eligibility. The position’s objective is to provide superior service in a cost-effective manner to achieve best possible outcomes as well as proactively collaborate across the enterprise to ensure alignment of objectives and foster continuous improvement. ESSENTIAL FUNCTIONS: 1. Gathers relevant facts by performing three-point contacts with involved parties and completing a thorough claim investigation prior to issuing a compensability determination. 2. Decides the outcome of claims using sound judgment and applying established policy, procedures, regulations, and guidelines. 3. Evaluates and establishes an action plan to manage benefits associated with primarily medical only and occupational disease claims to their most cost-effective conclusion. 4. Determines eligibility of benefits once medical treatment plans have been secured and processed within the designated authority levels. 5. Actively identifies and develops the investigation of and pursuit of subrogation recoveries when possible. 6. Utilize proactive reserving behaviors to ensure adequate case reserves which reflect the probable ultimate outcome based on the current known circumstances throughout the life of the claim. 7. Consults with lost time claims specialists and/or complex claims specialists, director or Claims Product and Operations staff, as needed. 8. Analyzes reports from external resources such as physicians, attorneys, and/or vocational rehabilitation experts to evaluate and adjust claim strategies as needed. 9. Evaluates and negotiates claim settlements utilizing human relation skills and technical knowledge to achieve the best possible outcome. 10. Consults with assigned claim director if the loss becomes more complex or presents increasing financial exposure. 11. Effectively and independently uses available resources to prioritize, organize, and complete work in a timely manner to meet jurisdictional requirements, timeframes, and internal metrics. 12. Follows established claims best practices related to medical management, litigation, fraud/abuse and recovery. 13. Presents claims and participates in discussion at team staffing. 14. Works collaboratively with the injured worker, employer, outside counsel, and health and rehabilitation professionals to manage the claims costs and promote quality medical care. 15. Along with the claim director, regional vice president and other claims staff, participates in claim reviews, onboardings, etc. for our policyholders and agents. 16. Proactively collaborate with our policyholders to ensure alignment of objectives and foster continuous improvement. OTHER FUNCTIONS: 1. Nonessential function: other duties as assigned. KNOWLEDGE, SKILLS AND ABILITIES: • Bachelor’s Degree from an accredited college or university is preferred. • One year of experience in the field of insurance, customer service, claims investigation, legal, rehabilitation, or medical claims processing required. Workers’ compensation claims experience and licensure preferred. • Must pass the claims adjuster license exam(s) as assigned within 6 months of being hired. • Preference may be shown to candidates with multiple state claims management experience. • Ability to use logic and sound reasoning to identify alternative solutions for problem-solving. • Strong written and verbal communication skills. • Strong analytical skills. • Ability to multitask and manage time effectively and productively. • Work effectively independently as well as in a team environment. • Develop and maintain strong, effective internal and external relationships. • Work effectively in a paperless environment. • Skilled in the use of laptops, claims management systems, and other typical business-related programs such as Microsoft Office suite. 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. With success in mind, we make an ongoing effort to provide an environment that offers challenging, stimulating, and financially rewarding opportunities. Join us to discover a work experience where you can learn and grow to your fullest potential. What you can expect from us In addition to a competitive compensation package, we offer a comprehensive benefits package designed to support the well-being and growth of our associates. Available benefits (subject to any policy or plan changes) include, but are not limited to: - Health, Dental & Vision Insurance - Company-provided life and income protection plans - Eligibility to participate in a 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 We believe that happy, healthy associates are the foundation of great work. Join us and thrive both professionally and personally. Encova Insurance is an EOE/E-Verify employer. #LI-Remote#LI-MF1

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Reviews and works accounts transferred to litigation for insurance information and attorney representation. Assesses and transfers new accounts to determine if a lien can be filed. Takes the necessary steps to follow through on lien filing. - Contacts attorneys and adjusters to follow through on case status and protection. - Sends bills, liens, and other information to attorneys and insurance companies. - Reviews and works adjuster-only accounts to file liens or track settlements. - Contacts insurance carriers regarding eligibility and timely filing deadlines. - Reviews and works liability elective accounts for providers that have requested settlement tracking, keeping in mind the timely filing deadlines. - Reviews accounts to determine if a lien can be filed and transfers to other litigation team members when feasible. - Performs special projects as assigned. Qualifications - Ability to work with various Microsoft Office products (Word, Excel, Outlook). - Ability to communicate effectively verbally and in writing. - Proven ability to produce accurate work while maintaining attention to detail when handling claims, often under minimal supervision. - Ability to organize and set priorities according to situational demands. - Proven sense of professional and personal judgment. - Ability to tolerate stress and effectively analyze and solve problems. - General understanding of relevant legal knowledge. Requirements - A quiet, distraction-free environment to work from in your home. - A secure internet connection is required. - Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads. - The workspace area accommodates all workstation equipment and related materials and provides adequate surface area to be productive. - Must reside in the United States within one of the specified states. Benefits - Paid training and incentive plans. - Medical, dental, vision, and life insurance benefits available from the first day of employment. - Excellent work/life balance. - Employee Resource Groups build community and foster a culture of belonging and inclusion. - 401(k) contributions matched. - Career growth opportunities. - 12 paid holidays and generous paid time off. - Pay: $15/hr.