Senior Return To Work Specialist

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.

The salary range for this job posting for candidates who reside in Pennsylvania is $65,152 - $116,752 annually + bonus + benefits The above represents the salary range for this job requisition in PA. Ultimately, in determining your pay, 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.

While we prefer candidates that reside in Pennsylvania, we will consider those who reside anywhere in our listed payroll states. We may hire a non-senior level for this role and the pay range is inclusive of both the non senior and senior level. This role will work remote from home and report to a Director, Workers' Compensation Claims.

An active certification by one of the following national recognized professional organizations is a requirement for this role: ABVE, CRC,CDMS, CCM.

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 Senior Return to Work Specialist supports the efforts of the team to seek opportunities for early intervention to identify early return to work opportunities and deployment of field case managers to assist the adjuster achieve the most cost effective and positive outcome from work-related injuries.

ESSENTIAL FUNCTIONS:
1. Collaborates with the Business Director in building the relationship with the policy holder by working and educating the policy holder on rehabilitation and safety matters.
2. Provides guidance and direction to other team members in relation to resolution of issues and problem solving.
3. Collaborates with the RTW Technical Coordinator in reviewing, development and implementation of best practices as needs arise.
4. Works with the Business Director and the RTW TC in coordination, evaluation and providing of staff training needs.
5. Acts as a go to technical resource to provide mentoring and leadership for fellow colleagues.
6. Assist the RTW TC in verifying outside vendors are adhering to rules and remaining compliant.
7. Assists and supports the business group leader through the facilitation of claims team meetings and staffing as requested.
8. Provides case management direction to outside field case managers including medical, RTW, physical restoration, vocational testing, job search, and retraining.
9. Keeps apprised of emerging trends, such as legal decisions, penalties, settlements, DOLI injuries, in workers' compensation.
10. Performs claims analysis and identifies trend factors on known high value incidents as requested and provides the information to the Business Teams.
11. Assists in the coordination of all aspects of disability management by ensuring an effective and efficient workflow of all disability management procedures and projects for the Business Groups as assigned.
12. Coordinates the disability management of all complex cases to facilitate a prompt, effective resolution.
13. Remains current with and adheres to best claim practices for return to work methodology
14. Introduces new techniques and ideas to the Business Group to streamline procedures and produce cost savings through increased understanding of effective disability management.
15. Provides claims adjuster support and follow-up to achieve successful return to work through individual or group staffing.
16. Contacts employer to obtain job analysis information on all loss time claims when return to work has not been achieved within the period expected
17. Coordinates return to work efforts with internal Nurse Case Managers and resolves customer service inquiries for external QRP's regarding authorizations, case staffing, and case direction.
18. Develops and approves in-house vocational rehabilitation plans for the claims adjuster.
19. Refers claims for task assignment or an initial vocational evaluation as appropriate and provides oversight of all task assignments for outcome and possible redirection or reassignment where expectations of Field Case Managers are not being met.
20. Reviews active claims for possible rehabilitation referrals
21. Authorizes appropriate rehabilitation plans and develops process improvement plans supporting the teams return to work initiatives.
22. Manages assigned workflow per day to include the review of reports submitted by external field cases managers, authorizing hours per the field case management activities, and approving vocational rehabilitation plans.
23. Handles designated case load of high exposure claims requiring special attention.
24. Assists with identifying and recommending efficiencies through technology.
25. Develops and participates in high exposure cases, including round table, medical/legal discussions, and rehabilitation staffing, to assist the claims management process.
26. Participates in authority issues regarding settlements, and reviews and monitors reserves within designated allocation.
27. Periodic travel, including meetings with policyholders.

OTHER FUNCTIONS:
1. Nonessential function: other duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES:
* Bachelor's degree from an accredited college or university, preferably in counseling, psychology, social work, nursing, business, risk management, insurance or Human Resources and
* Six years of full time or equivalent part time paid experience in vocational rehabilitation or field case management or a related field required.
* Master of Science degree in rehabilitation counseling preferred.
* If applicable, meets jurisdictional requirement for designation(s) such as rehabilitation provider or case management. For example, in West Virginia, WVQRP eligibility is required.
* One professional designation, such as CRC, CRRN, CCM, CLCP, LPC, NLCP, CDMS is preferred. Relevant expertise in the field of case management desired.
* Demonstrates ability to identify, analyze and resolve RTW issues (claim and policy)
* Demonstrates innovative problem solving and strategizing
* Demonstrates flexibility in assuming various roles and responsibilities
* Provide a level of customer service that allows internal and external customers to increase their skills and knowledge on RTW matters.
* Ability to assume leadership role with team
* Substantial knowledge of workers' compensation and/or casualty claims management.
* Exceptional communication skills with participation in a team environment and proven record of ability to collaborate with other business units for information gathering, reporting results, training, etc.
* Effective organizational skills including the ability to manage multiple projects and work with minimal direction.
* Excellent analytical research and documentation writing skills.
* Knowledge of medical terminology, medical codes and medications.
* Knowledge and skills to review medical case management results and to ensure the delivery of high quality services in compliance with industry best practices, internal policies and approved medical guidelines.
* Ability to work effectively in a paperless environment.

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.