Enlyte · 3 weeks ago
Senior Claims Analyst
United States
Full-time
Remote
Senior Level
$53K/yr - $77K/yr
5+ years expEnlyte is a company that combines innovative technology, clinical expertise, and human compassion to assist individuals recovering from workplace injuries or auto accidents. They are seeking a Senior Claims Analyst to independently investigate, evaluate, and resolve complex Workers’ Compensation claims while advocating for injured workers and delivering exceptional outcomes for clients.
Information TechnologySoftwareInformation Services
Responsibilities
Independently investigates, evaluates, and resolves assigned Workers’ Compensation claims of a more complex or litigated nature in a timely manner in accordance with legal statutes, policy provisions and company guidelines
Evaluate claimant eligibility; communicate with attending physician, employer and injured worker
Manage high exposure, complex and catastrophic claims
Work with both the claimant and their physician to medically manage the claim, from initial medical treatment to reviewing and evaluating ongoing treatment and related information
Work directly with employers to facilitate a return to work, either on a full-time or modified duty basis
Confirm coverage and applicable insurance policy or coverage document and statutory requirements
Identify potential for third party recovery, including subrogation, Second Injury Fund or other fund involvement (when applicable) and excess or reinsurance reimbursement. Pursue the process of reimbursement and complete posting of recovery to the claim file, where appropriate
Identify potential for disability or pension credits or offsets and apply same where appropriate
Ensure timely denial or payment of benefits in accordance with jurisdictional requirements
Establish claim reserve levels by estimating the potential exposure of each assigned claim, establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure
Establish compensability status through case investigation and evaluation and application of jurisdictional statutes and laws
Manage diary in accordance with Best Practices and complete tasks to ensure that cases move to the best financial outcome and timely resolution
Where litigation is filed, evaluate exposure and work with defense counsel to establish strong defenses, prepare litigation plan of action, set legal reserve and manage litigation over life of claim
Close all files as appropriate in a timely and complete manner
Maintain closing ratio as directed by management team
Oversee and coordinate medical treatment for injured employees and provide information to treating physicians regarding employees’ medical history, health issues, and job requirements; provide direction to assigned nurse case manager where applicable
Complete PARs (payment authorization request) when applicable
Comply with all excess and reinsurance reporting requirements; manage self-insured retention reporting
Qualification
Required
High School diploma required
Associate's or Bachelor's degree preferred, or five or more years of equivalent work experience required in an insurance, medical/health or legal related industry
Proficient with MS Excel and Word
Computer experience with related claims software
Excellent verbal and written communication skills
Proven interpersonal skills with all levels of personnel
Superior organizational skills
Customer-focused orientation
Teamwork and promotes cooperation and commitment within team
Time management and ability to control time to accomplish goals
Hard working, diligent, reliable, and has initiative
Expertise in Workers' Compensation and related claims handling practices and ability to apply same
Deep knowledge of client and carrier claims procedures
Significant understanding of self-insured retention, excess and reinsurance reporting
Preferred
Completion of Workers' Compensation training courses internally and/or externally in all significant areas affecting Workers' Compensation claims handling and practices
Benefits
Medical
Dental
Vision
Health Savings Accounts / Flexible Spending Accounts
Life and AD&D Insurance
401(k)
Tuition Reimbursement
An array of resources that encourage a lifetime of healthier living
Company
Enlyte
Enlyte is an information service company that provides case management, clinical software, and auto-physical damage solutions.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
J
Jen Herbert
Vice President, Specialty Sales
Keith Higdon
President, Customer and Market Operations
Recent News
2026-06-02
PR Newswire
2026-04-06
2026-01-22
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