Director, Workers' Compensation Claims

The salary range for this job posting is $108,812.00 - $174,099.00 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.

Based upon certain geographical locations, such as Illinois and Pennsylvania, a higher salary range is applicable.

This role will manage the Large Midwest claims team and report to a Regional Vice President, Commercial Lines.  

Candidates will reside in any of our listed payroll approved states.

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 Director, Workers’ Compensation Claims is responsible for oversight of the day-to-day performance of the business team claims adjusters, return-to-work specialists, and nurse case managers.   In the regional offices, the safety & loss control consultants (SLC) on the business team will also have a dotted line report to this position. 

This position’s objective is to provide leadership that assures superior, cost-effective service and compliance with adopted best claims practices, and loss control practices if applicable, to eliminate unwarranted loss.

ESSENTIAL FUNCTIONS:  
1.    Supervise claims management activities for the business team members.
2.    Ensure that new policyholders are properly on-boarded. Track these results using Encova systems.
3.    Evaluate and assign claims to team adjusters, following proper protocols.
4.    Provide guidance to assist with identification of possible complications related to developing injury/exposure claims.
5.    Assure establishment of appropriate reserve values throughout the life of the claim. Approve and adjust reserves as necessary.
6.    Consult with internal/external medical, legal, and vocational professionals on current and/or recommended treatment, litigation or rehabilitation plans to assist the adjuster in reaching achievable and appropriate claim outcome.
7.    Analyze medical, legal and vocational rehabilitation reports compared to established guidelines. Advise staff on findings outside of established guidelines. 
8.    Supervise and assist business team claims staff with investigation, evaluation and settlement of assigned claims thru application of technical knowledge and human relation skills to effect fair and prompt claim closure and to contribute to a reduced loss ratio.
9.    Support and assist claims staff with the investigation and pursuit of subrogation recoveries.
10.    Participate in claim discussions at team staffing. Provide guidance when needed.
11.    Represent the organization on special projects; carry out speaking engagements for local meetings or conferences.
12.    Train and mentor new associates on claims and unit procedures.
13.    Work collaboratively with team adjusters, outside counsel, injured employee, employer, health and rehabilitation professionals to manage claim costs, promote quality medical care and timely return-to-work (RTW) to achieve optimum cost-effective medical and vocational outcomes. 
14.    Perform file reviews for claims staff as part of the Quality Assurance program to assure that claims are being handled in accordance with the company’s set best practices.
15.    Facilitate meetings with policyholders, both independent of and in concert with the Business Director.
16.    Work collaboratively with Claims Operations and the Best Practice Leader on projects involving claim policies, procedures and best practices. 
17.    Identify, develop, and a