Encova Insurance

Insurance

JOB OBJECTIVE: The Lost Time Claims Specialist, Workers’ Compensation primarily manages indemnity claims.
The Lost Time 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 Lost Time Claims Specialist also serves as a resource to Medical Only Claims Specialists and Claims Specialist Trainees.
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. Evaluates and establishes an action plan to manage medical and indemnity benefits associated with injury and occupational disease claims to their most cost- effective conclusion.
2. Decides the outcome of the claim using sound judgment by applying established policy, procedures, regulations and guidelines.
3. Gathers facts by conducting interviews with all involved parties and considers all the elements of the claim prior to issuing a decision.
4. Take recorded statements when necessary.
5. Determines eligibility of indemnity and medical benefits once salary information and medical treatment plans have been secured and processed within the designated authority levels.
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. Actively identifies and develops the investigation of and pursuit of subrogation recoveries when possible.
8. Consults with assigned claim director, return to work specialists, nurse case managers, internal/external medical, and legal on current and/or recommended treatment, litigation or rehabilitation plans to ensure claims outcomes are achievable and appropriate.
9. Works collaboratively with the injured worker, employer, outside counsel, and health and rehabilitation professionals to manage the claims costs and promote quality medical care.
10. Works collaboratively with the injured worker, employer, assigned return to work specialist, and medical providers to facilitate the injured worker’s safe and timely return to work.
11. Manages claims litigation, including expenses, by collaborating and providing direction to panel counsel throughout the life of the claim.
12. Analyzes reports from external resources such as physicians, attorneys, and/or vocational rehabilitation experts to evaluate and adjust claim strategies as needed.
13. Evaluates and negotiates claim settlements utilizing human relation skills and technical knowledge to achieve the best possible outcome.
14. Presents and summarizes claim details at internal team staffing, participates in discussions, and provides guidance as needed.
15. Consults with assigned claim director if the loss becomes significantly complex or presents significantly increasing financial exposure.
16. Follows established claims best practices related to medical management, litigation, fraud/abuse and recovery.
17. Effectively and independently uses available resources to prioritize, organize, and complete work in a timely manner to meet jurisdictional requirements, timeframes, and internal metrics.
18. Develops presentations for special projects such as internal/external meetings and conferences as needed.
19. Along with the claim director, regional vice president and other claims staff, participates in claim reviews, onboardings, etc. for our policyholders and agents.
20. Proactively collaborate with our policyholders to ensure alignment of objectives and foster continuous improvement.
OTHER FUNCTIONS: 1. Nonessential function: other duties as assigned.

Lost Time Claims Specialist, Workers' Compensation

The Lost Time Claims Specialist, Workers’ Compensation primarily manages indemnity claims.
Responsible for investigation, evaluation, and determination of compensability for work-related injury and disease claims.
Provides superior service in a cost-effective manner to achieve best outcomes and collaborate across enterprise.
Evaluates and establishes an action plan to manage medical and indemnity benefits associated with injury and occupational disease claims.
Decides outcome of claims using established policy, procedures, regulations and guidelines.
Gathers facts via interviews and recorded statements when necessary.
Determines eligibility of indemnity and medical benefits once salary info and medical treatment plans processed.
Utilizes proactive reserving behaviors to ensure adequate case reserves.
Identifies and pursues subrogation recoveries when possible.
Consults with claim director, return to work specialists, nurse case managers, internal/external medical, and legal.
Works collaboratively with injured worker, employer, outside counsel, and health and rehabilitation professionals.
Facilitates injured worker’s safe and timely return to work.
Manages claims litigation and collaborates with panel counsel.
Analyzes reports from external resources to evaluate and adjust claim strategies.
Evaluates and negotiates claim settlements.
Presents claim details at internal team staffing; participates and provides guidance.
Consults with claim director if loss becomes complex or financially exposed.
Follows claims best practices related to medical management, litigation, fraud/abuse and recovery.
Uses available resources to prioritize, organize, and complete work timely to meet jurisdictional requirements.
Develops presentations for special projects.
Participates in claim reviews, onboardings, and policyholder/agent interactions.
Proactively collaborates with policyholders to ensure alignment and continuous improvement.

Consultant

• The Safety and Loss Control Consultant conducts loss analysis and research prior to conducting on-site occupational safety and loss prevention surveys to assess the policy holder's safety efforts and to detect occupational safety hazards to employees.\n• The Safety and Loss Control Consultant prepares and submits reports of findings to management and makes recommendations to management to correct hazards and safety and loss control program needs.\n• This position also participates in management training programs; researches literature, laws, standards and technical developments in the field of safety and loss control and provides the Underwriting Department with risk assessments in support of underwriting determinations.\n• The Consultant works with standard to large accounts and accounts that present more complex hazard and safety issues.\n• The Consultant may mentor and provide guidance to Safety and Loss Control Trainees as needed.\n• The Consultant participates in training sessions for policyholders in conjunction with Senior Safety and Loss Control Consultants.\n• This requires a vast working knowledge and experience with all aspects of loss control regarding all property and casualty coverages written by Encova: • General and Products Liability • Workers’ Compensation • Property • Auto/Fleet • Risk Improvement\nESSENTIAL FUNCTIONS: 1. Consults with policy holders to improve the occupational safety programs and performance leading to a safer and healthier workplace. 2. Provides underwriters with information concerning the level of safety of policy holders 3. Evaluates policy holder safety programs and work sites for hazardous conditions 4. Conducts simple Industrial Hygiene testing. 5. Researches literature, standards, laws, and rules to provide policy holders with effective solutions. 6. Develops cost effective methods to correct hazardous conditions. 7. Analyzes loss information to determine accident trends and provide policy holders with effective solutions. 8. Provides underwriting with accurate and timely reports on the hazards and the effectiveness of controls and the willingness of the policy holder to comply with recommendations to control hazards. 9. Keeps underwriting apprised of any changes in hazards or exposures through copies of reports to policy holders and special reports to underwriting. 10. Responds to requests from policy holders, underwriters, and other agencies in a timely fashion regarding safety issues. 11. Communicates ideas and issues with management to reach successful agreement through innovation, creativity, and compromise. 12. Provides leadership and motivation of the support staff to achieve loss control goals and objectives. OTHER FUNCTIONS: 1. Nonessential function: other duties as assigned. KNOWLEDGE, SKILLS AND ABILITIES: • Bachelor’s degree from an accredited college or university required. Preferably in safety, industrial hygiene, engineering or related field. • Preference may be given to applicants with master's degree in Safety or Industrial Hygiene from an accredited college or university. • Preference may be given to applicants with two years of full-time or equivalent part-time paid occupational safety management or occupational safety management consulting experience in industry or insurance. • Certified Safety Professional (CSP), Certified Industrial Hygienist (CIH), Certification as an Associate in Risk Management (ARM), Associated Safety Professional (ASP) are preferred. • Knowledge of the various core elements within the occupational safety and industrial hygiene process. • Knowledge of effective safety program management. • Knowledge of risk management as it relates to safety and industrial hygiene as an overall function of business in planning, leading, and directing its operations. • Knowledge of workers' compensation laws, policies and rules, as well as understanding of the principles of insurance and risk management. • Basic understanding of guaranteed cost, deductibles, retrospective rating plans and the impact of accident prevention on each plan. • Knowledge of the rating systems, methods of calculating experience modification factors and the elements of each formula. • Understanding of the U. S. Department of Labor Bureau of Labor Statistics loss information, formulas and principles of calculating incidence rates for policy holders. • Knowledge of basic business financial principles to analyze cost effectiveness and return on investment of recommended solutions to hazards and exposures. • Ability to make sound judgments and work independently, and to establish and maintain effective working relationships with other policy holders, policyholders, regulatory agencies, and labor communities. • Working knowledge of Microsoft Word, Excel and PowerPoint. • Ability to compile, analyze, and report on findings. • Knowledge of Federal OSHA MSHA, DOT and NFPA standards. • Ability to communicate effectively, both orally and in writing. • Ability to safely operate a motor vehicle. • Must hold a valid driver’s license. 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 your diverse ideas will be met with enthusiasm – where you can learn and grow to your fullest potential. What you can expect from us Join our family of industry leaders, and let us reward you with a competitive salary, bonus and benefits package that includes but is not limited to: a 401(k), wellness programs, bonus incentive plans and flexible schedules, with an early close of the office every Friday. Additionally, Encova aspires to be an outstanding corporate citizen in all the markets we serve; we encourage and support associate participation in community initiatives through our foundations. Encova Insurance is an EOE/E-Verify employer. Life at Encova At Encova our associates are the heart of our business. Our exceptional culture makes it a special place to work and gives us a unique advantage. Building and sustaining this culture requires intentional effort from everyone in the company. We believe that achieving results and building trust are interrelated. Through connection, character and competence, we build trusting relationships with associates, agents and policyholders to achieve excellent results. Through our collaborative team structure we find professional and personal growth. We never stop learning and always seek to improve ourselves. At Encova, we know that inclusion and belonging foster our competitive edge by giving voice to every individual’s unique talent and perspective; and we believe that when a condition of equity exists, all associates can contribute to the fullest extent of their knowledge, skills and ability. Read More Job Alerts Don't see the dream job you are looking for? Click Sign In at the top right corner of the screen to access Job Alerts . Here you can select your job search criteria using filters. You will be notified via email if a new position becomes available that matches your requirements. Read More 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. Read More Discover Encova in our Community Encova Internship Experience Follow Us Privacy Policy © 2025 Workday, Inc. All rights reserved.

Safety and Loss Control Consultant

Analyst

• JOB OBJECTIVE : The SIU Investigative Analyst is responsible for identifying , analyzing, and investigating potentially fraudulent insurance claims or suspicious activities across various lines of business. This role investigates potentially fraudulent insurance claims by triaging SIU referrals, conducting research (including OSINT and social media), occasional recorded statements, and collaborating with investigators, claims professionals, legal and law enforcement. This role ensures regulatory compliance and supports effective fraud resolution. Strong analytical skills and fraud detection expertise are essential. • ESSENTIAL FUNCTIONS : Review insurance claims, applications and other documentation for potential fraud indicators or misrepresentation using internal and external systems and databases. Identify emerging fraud trends and contribute to the development of predictive analytics or fraud detection strategies. Review referred SIU claims and identify the scope of investigation needed. Conduct detailed investigations by analyzing data, obtaining statements, and working with field investigators. This role is primarily desk based with limited travel or fieldwork. Investigations requiring fieldwork should be assigned to a field SIU Investigator. Assist SIU investigators in compiling case documentation and evidence. Compile and document case files with findings, evidence, and recommendations. Prepare reports and referrals to management, law enforcement, regulatory bodies, or state fraud bureaus, as required. Monitor industry alerts and trends related to fraud schemes and tactics including relevant laws, regulations, and procedures governing insurance fraud. Coordinate with internal departments (e.g., Claims, Legal, Compliance) and external entities as necessary. Maintain detailed case records and ensure all information is logged accurately. • OTHER FUNCTIONS : Complete various special projects and investigations as assigned. Network with industry personnel, law enforcement, legal counsel and others to develop information for investigative analysis and leads. Act as a subject matter resource providing fraud awareness, investigative consultation and mentorship to company associates. Perform other duties as assigned. • KNOWLEDGE, SKILLS AND ABILITIES : Bachelor's degree in criminal justice, business, insurance, or a related field or equivalent experience is preferred. Experience in claims processes, investigation, fraud detection, or a related field is desired. Strong analytical, research, and problem-solving skills. Knowledge of fraud schemes and regulatory requirements (e.g., NICB, SIU compliance) is strongly preferred. Proficiency with investigative tools, databases, and reporting systems. Excellent written and verbal communication skills. Multi-line insurance background is a plus. Continuing insurance education is desired and may be obtained through designation training offered by industrial organizations such as IASIU. 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 your diverse ideas will be met with enthusiasm – where you can learn and grow to your fullest potential. What you can expect from us Join our family of industry leaders, and let us reward you with a competitive salary, bonus and benefits package that includes but is not limited to: a 401(k), wellness programs, bonus incentive plans and flexible schedules and a early close of the office every Friday. Additionally, Encova aspires to be an outstanding corporate citizen in all the markets we serve; we encourage and support associate participation in community initiatives through our foundations. Encova Insurance is an EOE/E-Verify employer. Life at Encova At Encova our associates are the heart of our business. Our exceptional culture makes it a special place to work and gives us a unique advantage. Building and sustaining this culture requires intentional effort from everyone in the company. We believe that achieving results and building trust are interrelated. Through connection, character and competence, we build trusting relationships with associates, agents and policyholders to achieve excellent results. Through our collaborative team structure we find professional and personal growth. We never stop learning and always seek to improve ourselves. At Encova, we know that inclusion and belonging foster our competitive edge by giving voice to every individual’s unique talent and perspective; and we believe that when a condition of equity exists, all associates can contribute to the fullest extent of their knowledge, skills and ability. Read More Job Alerts Don't see the dream job you are looking for? Click Sign In at the top right corner of the screen to access Job Alerts . Here you can select your job search criteria using filters. You will be notified via email if a new position becomes available that matches your requirements. Read More 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. Read More Discover Encova in our Community Encova Internship Experience Follow Us Privacy Policy © 2025 Workday, Inc. All rights reserved.