Enlyte · 6 hours ago
Claims Representative 1
United States
Full-time
Remote
Entry Level
$16.53/hr - $19.47/hr
1+ years expEnlyte is a company that combines innovative technology, clinical expertise, and human compassion to assist individuals recovering from workplace injuries or auto accidents. The Claims Representative 1 role involves evaluating claims, communicating with relevant parties, and ensuring timely benefits payments while providing excellent customer service.
Information ServicesInformation TechnologySoftware
Responsibilities
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
Qualification
Required
High School Diploma required
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
Preferred
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
Knowledge of Workers' Compensation legal principles and related claims handling practices preferred
Benefits
Medical
Dental
Vision
Health Savings Accounts / Flexible Spending Accounts
Life and AD&D Insurance
401(k)
Tuition Reimbursement
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
Recent News
2026-01-22
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