Encova Insurance

Claims Specialist

• Manages a high frequency desk, which includes primarily medical only claims.
• Responsible for the investigation, evaluation, and determination of compensability for work-related injury and disease claims following established guidelines to determine benefit eligibility.
• Provides superior service in a cost-effective manner to achieve best possible outcomes and proactively collaborate across the enterprise to ensure alignment of objectives and foster continuous improvement.
• Gathers relevant facts by performing three-point contacts with involved parties and completing a thorough claim investigation prior to issuing a compensability determination.
• Decides the outcome of claims using sound judgment and applying established policy, procedures, regulations, and guidelines.
• Evaluates and establishes an action plan to manage benefits associated with primarily medical only and occupational disease claims to their most cost-effective conclusion.
• Determines eligibility of benefits once medical treatment plans have been secured and processed within the designated authority levels.
• Actively identifies and develops the investigation of and pursuit of subrogation recoveries when possible.
• Utilizes 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.
• Consults with lost time claims specialists and/or complex claims specialists, director or Claims Product and Operations staff, as needed.
• Analyzes reports from external resources such as physicians, attorneys, and/or vocational rehabilitation experts to evaluate and adjust claim strategies as needed.
• Evaluates and negotiates claim settlements utilizing human relation skills and technical knowledge to achieve the best possible outcome.
• Effectively and independently uses available resources to prioritize, organize, and complete work in a timely manner to meet jurisdictional requirements, timeframes, and internal metrics.
• Follows established claims best practices related to medical management, litigation, fraud/abuse and recovery.
• Works collaboratively with the injured worker, employer, outside counsel, and health and rehabilitation professionals to manage the claims costs and promote quality medical care.
• Along with the claim director, regional vice president and other claims staff, participates in claim reviews, onboardings, etc. for our policyholders and agents.
• Proactively collaborates with our policyholders to ensure alignment of objectives and foster continuous improvement.

Medical Only Claims Specialist – Workers' Compensation

Auditor

• Conduct audits primarily by phone examination of an employer’s accounting records to verify and record classification information to ensure premium payments are correct and in compliance with applicable laws.
• May complete mail audits as assigned.
• Prepare audit worksheets to support audit adjustments and recommendations, and document audit trail.
• Develop and determine premium basis, earned premium, and classification in accordance with company, industry and government rules and regulations.
• Effectively communicate audit results to internal and external customers regarding classification or payroll variances.
• Ensure quality of audit through proper risk classification and exposure basis identification.
• Maintain knowledge of current trends and developments in the field.
• Use related internal systems as required to perform duties.

Premium Auditor

Sales

• Lead, develop, and scale the Commercial Lines Inside Sales team supporting agents without an assigned agency manager.
• Define and execute inside sales strategies aligned with company’s growth, appetite, and profitability goals.
• Establish sales targets, KPIs, and production benchmarks for the inside sales team across account sizes and product lines.
• Drive consistent sales execution, accountability, and pipeline discipline.
• Partner with agency managers (production underwriters and territory managers) and leaders to support agent growth, engagement, and penetration.
• Collaborate with agency operations and marketing on new agency onboarding, growth planning, and territory strategies using inside sales resources.
• Own the design and delivery of sales training programs for all commercial lines underwriters and territory managers.
• Train teams on consultative selling, coverage positioning, value-based conversations, and objection handling.
• Develop sales playbooks, talking points, and tools aligned with commercial lines underwriting appetite and growth strategy.
• Ensure business teams are equipped to effectively influence and support agent sales outcomes.
• Work closely with underwriting leadership to align sales execution with risk selection and pricing strategy.
• Partner with product, operations, and marketing teams to support launches, campaigns, and market initiatives.
• Serve as a key liaison between sales, underwriting, and distribution leadership.
• Analyze sales performance, submission-to-bind ratios, and pipeline trends for assigned agencies.
• Leverage CRM and sales analytics to improve forecasting, activity management, and productivity.
• Identify opportunities to improve speed to quote, close ratios, and agent experience for assigned agencies.
• Champion sales process improvements, automation, and enablement tools.

Director, Sales Excellence – Commercial Lines

Security Operations

• Assist higher level specialists in cybersecurity measures.
• Provide timely detection, identification, and alerting of possible attacks/intrusions, anomalous activities, and misuse activities.
• Perform security incident triage, determining scope, urgency, and potential impact.
• Identify specific vulnerabilities and make recommendations for expeditious remediation.
• Work on various Information Security projects and initiatives.
• Perform user account clean-up and security platform clean-up, including intrusion detection tuning.
• Build reports, dashboards, alerts, and automation in SIEM tools.

IT Security Operations Intern

Director

• Lead a technical team and develop strategies to manage medical expenses within the workers’ compensation program.
• Ensure compliance with regulatory requirements and oversee vendor relationships.
• Implement best practices to deliver quality care while controlling costs.
• Provide leadership through coaching, mentoring, and directing the medical network, provider relations, and medical bill review teams.
• Develop and implement medical cost containment strategies aligned with organizational goals.
• Monitor industry trends and regulatory changes to ensure compliance and optimize performance.
• Manage provider networks, utilization review, bill review, and pharmacy benefit programs.
• Analyze medical cost drivers and identify opportunities for savings.
• Prepare reports and present findings to senior leadership with actionable recommendations.

Medical Only Claims Specialist – Workers' Compensation

Premium Auditor

Director, Sales Excellence – Commercial Lines

IT Security Operations Intern

Director, Provider Relations and Medical Networks