Lost Time Claims Specialist – Workers' Compensation
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Job Description
Workers’ compensation claims specialist managing indemnity claims for Encova Insurance. Investigating compensability, coordinating litigation, and driving cost-effective claim outcomes.
Responsibilities:
- Manage indemnity and medical workers’ compensation claims through cost-effective resolution.
- Investigate, evaluate, and determine compensability of work-related injury and occupational disease claims.
- Establish action plans for medical and indemnity benefits.
- Apply policies, procedures, regulations, and guidelines to determine claim outcomes and benefit eligibility.
- Conduct interviews and take recorded statements when necessary.
- Secure and process salary information and medical treatment plans within designated authority levels.
- Maintain adequate case reserves based on probable claim outcomes.
- Identify and pursue subrogation recoveries.
- Consult with claim directors, return-to-work specialists, nurse case managers, medical professionals, and legal counsel.
- Collaborate with injured workers, employers, counsel, and healthcare and rehabilitation professionals to manage costs and promote quality care.
- Facilitate safe and timely return to work.
- Manage claim litigation and direct panel counsel.
- Analyze reports from physicians, attorneys, and vocational rehabilitation experts.
- Evaluate and negotiate claim settlements.
- Present claim details at internal team staffing and provide guidance.
- Escalate significantly complex claims or increasing financial exposure.
- Follow claims best practices for medical management, litigation, fraud/abuse, and recovery.
- Prioritize and complete work according to jurisdictional requirements, timeframes, and internal metrics.
- Develop presentations for special projects, meetings, and conferences.
- Participate in claim reviews, onboardings, and policyholder and agent activities.
- Collaborate with policyholders to align objectives and foster continuous improvement.
Requirements:
- Bachelor’s Degree from an accredited college or university is preferred.
- Three years of experience in the field of workers’ compensation insurance required.
- Ability to manage claims through the litigation process.
- One valid workers’ compensation adjuster license is strongly preferred.
- Must be eligible to obtain additional licenses as required.
- Must pass the claims adjuster license exam(s) as assigned within 90 days of being hired.
- Preference may be shown to candidates with multiple state claims management experience.
- Experience in workers’ compensation claims practices and 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 multitasks and manage time effectively and productively.
- Work effectively independently as well as 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 other typical business-related programs such as Microsoft Office suite.
- Candidates may reside in any of Encova’s listed payroll approved states.
- Must pass required claims adjuster license exams within 90 days of hire.
Benefits:
- Bonus
- Health, Dental & Vision Insurance
- Company-provided life and income protection plans
- Eligibility to participate in a company incentive bonus program
- 401(k) Retirement Plan - 100% company match up to 7% on annual salary
- Paid Time Off, Paid Holidays, and Floating Holidays
- Flexible Work Arrangements - Hybrid and remote depending on the role
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