Claims Analyst

The above represents the 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. Your recruiter can share more information about the specific salary range during the hiring process.

Encova Insurance has an opening for a Claims Analyst reporting to the Director, Claims Product and Operations. This role will have the option to be home-based from any state where we can hire as seen on our careers page.

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 Claims Analyst role evaluates and implements claims best practices and assesses the effectiveness of their execution. This position researches and develops claims-related tools and processes, which are necessary to achieve cost-effective business results for a multi-state book of business. This position will train, develop, facilitate, and evaluate associate learning, education, and continuous improvement programs.This position will also conduct quality assurance reviews on various claims related disciplines.

ESSENTIAL FUNCTIONS:

• Assist in the development of guidelines, policies and procedures, identify opportunities, and make recommendations to improve quality, service, efficiency, and effectiveness of claim handling.
• Assist in the design, development, organization, and facilitation of learning programs for claims business teams and other staff. This includes areas such as claims handling best practices, insurance coverages, strategies, negotiation techniques, processes and workflows, and technical skill development.
• Evaluate the overall effectiveness of internal and external programs and resources.
• Develop, maintain, and facilitate a claims new-hire learning and education program.
• Collaborate with claims leadership to recommend learning and development plans targeted to claims associates' individual strengths, interests, and improvement opportunities.
• Leverage available technology to deliver educational opportunities using online, real-time web-conferencing and other e-learning tools.
• Organize, update, and maintain claims training materials and resources.
• Develop and publish claims training schedules and maintain training records.
• Develop quality assurance processes and procedures, and assist in determining the subject matter, direction and focus of quality assurance projects.
• Conduct objective, detailed, quality assurance reviews on open and closed claim files to ensure that claims activities comply with regulatory requirements, fair claims practices, and Encova's best practices.
• Perform quality assurance reviews of external vendors to ensure compliance with Encova's policies, procedures, and quality standards.
• As needed to address associate performance improvement opportunities, work with claim leadership to conduct desk reviews.
• Maintain an ongoing understanding of claims processes, procedures, and systems. Investigate compliance and/or regulatory issues and maintain continued awareness of fair claims practices laws, compliance issues, and business-related developments.
• Assist in the implementation of product and service initiatives.
• Analyze, evaluate, and respond to specific complaints and inquiries regarding claim related issues.

OTHER FUNCTIONS:

• Analyze claims system information to identify system defects and impacts of process and/or system changes. Conduct claims system updates, auditing, and testing as needed.
• Notify affected associates of claims systems issues and/or changes.
• Monitor, review and update claims systems for unassigned claims as needed.
• Create and run queries, reports, and other analytics on claims systems, and generate and submit reports as needed.
• Occasional travel including some overnight travel as needed.
• Perform other duties and projects as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES:

• This position requires a college degree or equivalent experience, and a strong understanding of property casualty insurance and policies.
• This position requires a minimum of three years' experience in property/casualty and or workers' compensation claims.
• Continuing education such as Associate in Claims (AIC) and/or Chartered Property Casualty Underwriter (CPCU) designations is strongly preferred.
• A thorough understanding of claims investigation, evaluation, and resolution techniques, claims handling processes and procedures, file documentation, personal and commercial insurance coverages (including workers compensation) and their application, and negotiation techniques is required.
• Familiarity of fair claims practices laws, and the ability to read, interpret, train, and systematically apply regulatory requirements and claims statutes for a multi-state book of business.
• Experience in training and/or quality assurance is desirable.
• Excellent verbal and written communication skills are required including the ability to design, write and compile business and technical documentation and reports.
• This position requires proven analytical and problem-solving skills, and the ability to work in a team environment, provide coaching/mentoring and manage assigned projects.
• Proficiency in MS Word, Excel and PowerPoint is required.

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.