Claims Adjuster 1

At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth.

Be part of a team that makes a real difference.

This is a full-time remote position that can be located anywhere in the U.S.

• Complete internal training in adjusting medical only workers' compensation claims.
• Evaluate claimant eligibility; communicate with attending physician, employer and injured worker.
• Confirm coverage and applicable insurance policy or coverage document and statutory requirements.
• Establish compensability status through case investigation and evaluation and application of jurisdictional statutes and laws.
• Ensure timely payment or denial of benefits in accordance with jurisdictional requirements.
• Identify potential for third party recovery, including subrogation.
• Pursue the process of reimbursement and complete posting of recovery to the claim file, where appropriate.
• Investigate potentially suspect claims possibly with the aid of a field investigator assignment.
• Establish claim reserve levels by estimating the potential exposure of each assigned claim, documenting rationale; maintain and adjust reserves over the life of the claim to reflect changes in exposure.
• Manage diary in accordance with Best Practices and complete tasks to ensure that cases move to the best financial outcome and timely resolution.
• Close all files as appropriate in a timely and complete manner, maintaining closing ratio as directed by management team.
• Oversee and coordinate medical treatment for injured employees and provide information to treating physicians and/or nurse case managers regarding employees' medical history, health issues, and job requirements; provide direction to assigned nurse case manager where applicable.
• Work directly with employers to facilitate return to work, either on a transitional duty or full-time basis.
• Complete PARs (payment authorization request) or CARs (claims analysis report) when applicable.
• Communicate effectively, verbally and in writing with internal and external parties on a wide variety of claims and account-related issues.
• Provide a high degree of customer service to clients, including face to face interactions during claim reviews, meetings and similar account-specific sessions.
• Perform other duties as required.

• High School Diploma required.
• Associate's degree preferred, or one or more years of insurance, medical/health or legal related work experience.
• 1-2 years of experience handling workers' compensation claims preferred.
• Proficient with MS Excel and Word; computer experience with related claims software.
• Excellent verbal and written communication skills
• Proven interpersonal skills capable of dealing with all levels of personnel.
• Knowledge of Workers' Compensation legal principles and related claims handling practices preferred.

PI270156071