Remote Fraud Analyst Jobs in Springfield, IL (NOW HIRING)

Compensation The salary range for this position is $55,132.00 - $110,642.00 annually, plus bonus and benefits. For candidates residing in Illinois, the range is $59,630 - $119,670 annually, plus bonus and benefits. Salary determination will consider location, education, experience, and job‐related factors. Job Objective The Lost Time Claims Specialist, Workers' Compensation primarily manages indemnity claims. The specialist investigates, evaluates, and determines compensability for work‐related injury and disease claims, following established guidelines. The role also supports Medical Only Claims Specialists and Claims Specialist Trainees and delivers cost‐effective service while collaborating across the enterprise. Essential Functions Evaluate and establish an action plan to manage medical and indemnity benefits for injury and occupational disease claims to a cost‐effective conclusion. Decide claim outcomes using established policy, procedures, regulations and guidelines. Gather facts by conducting interviews with all involved parties and consider all elements of the claim before issuing a decision. Take recorded statements when necessary. Determine eligibility of indemnity and medical benefits once salary information and medical treatment plans have been secured and processed within the designated authority levels. Utilize proactive reserving to ensure adequate case reserves that reflect the probable ultimate outcome based on current known circumstances. Identify and pursue subrogation recoveries when possible. Consult with claim director, return‐to‐work specialists, nurse case managers, internal/external medical and legal professionals on current and/or recommended treatment, litigation or rehabilitation plans to ensure outcomes are achievable and appropriate. Collaborate with injured worker, employer, outside counsel and health and rehabilitation professionals to manage claim costs and promote quality medical care. Collaborate with injured worker, employer, assigned return‐to‐work specialist and medical providers to facilitate a safe and timely return to work. Manage claim litigation, including expenses, by collaborating with and directing panel counsel throughout the life of the claim. Analyse reports from external resources such as physicians, attorneys, and vocational rehabilitation experts to evaluate and adjust claim strategies as needed. Evaluate and negotiate claim settlements using technical knowledge and human‐relation skills to achieve the best possible outcome. Present and summarize claim details at internal staffing meetings and provide guidance as needed. Consult claim director if a loss becomes significantly complex or presents increased financial exposure. Follow best practices related to medical management, litigation, fraud/abuse and recovery. Prioritize, organize and complete work in a timely manner to meet jurisdictional requirements, time frames and internal metrics. Develop presentations for special projects such as internal and external meetings and conferences as needed. Participate in claim reviews, onboardings and other activities with claim director, regional vice‐president and other claim staff for policyholders and agents. Proactively collaborate with policyholders to ensure alignment of objectives and foster continuous improvement. Other Functions Nonessential duties as assigned. Knowledge, Skills and Abilities Bachelor's Degree from an accredited college or university is preferred. Three years of experience in workers' compensation insurance is required. Ability to manage claims through the litigation process. Internal candidates must demonstrate knowledge of Encova Best Practices guidelines and meet quality standards. One valid workers' compensation adjuster license is strongly preferred; eligibility to obtain additional licenses required. Must pass the claims adjuster license exam(s) within 90 days of hire. Preference may be given to candidates with experience managing claims in multiple states. Experience in workers' compensation practices, laws, court procedures, precedents and state statutes. Ability to use logic and sound reasoning to identify alternative solutions for problem solving. Strong written and verbal communication skills. Strong analytical skills. Ability to multitask and manage time effectively and productively. Work effectively independently and in a team environment. Develop and maintain strong, effective internal and external relationships. Work effectively in a paperless environment. Skilled in the use of laptops, claims management systems and common business programs such as Microsoft Office. Benefits Health, dental and vision insurance Company‐provided life and income protection plans Eligibility to participate in company incentive bonus program 401(k) retirement plan with 100% company match up to 7% of annual salary Paid time off, paid holidays and floating holidays Flexible work arrangements – hybrid or remote depending on the role Additional Information Encova Insurance makes every effort to accommodate disabilities as required by the Americans with Disabilities Act. Employees who need accommodations are encouraged to seek them. Encova Insurance is an equal‐opportunity employer and participates in E‐Verify. #J-18808-Ljbffr