Lost Time Claims Specialist – Workers' Compensation

This is a fully remote position, open to applicants in Connecticut, +22 more states.

📋 Description

• Oversee the resolution of indemnity and medical workers’ compensation claims in a cost-effective manner.

• Investigate, assess, and establish the compensability of claims related to work injuries and occupational diseases.

• Develop action plans for medical and indemnity benefits.

• Implement policies, procedures, regulations, and guidelines to ascertain claim outcomes and benefit eligibility.

• Conduct interviews and take recorded statements when necessary.

• Obtain and process salary information and medical treatment plans within established authority levels.

• Maintain appropriate case reserves based on anticipated claim outcomes.

• Identify and pursue recovery through subrogation.

• Consult with claim directors, return-to-work specialists, nurse case managers, medical professionals, and legal counsel.

• Collaborate with injured workers, employers, legal counsel, and healthcare and rehabilitation professionals to manage costs and ensure quality care.

• Promote safe and timely return-to-work initiatives.

• Oversee claim litigation and direct panel counsel.

• Analyze reports from physicians, attorneys, and vocational rehabilitation specialists.

• Assess and negotiate claim settlements.

• Present claim details in internal team staffing meetings and provide guidance.

• Escalate complex claims or those with increasing financial exposure.

• Adhere to best practices for medical management, litigation, fraud/abuse, and recovery.

• Prioritize and complete tasks in accordance with jurisdictional requirements, timelines, and internal metrics.

• Create presentations for special projects, meetings, and conferences.

• Participate in claim reviews, onboarding, and activities involving policyholders and agents.

• Work with policyholders to align goals and encourage continuous improvement.

⛳️ Requirements

• A Bachelor's Degree from an accredited institution is preferred.

• A minimum of three years of experience in the workers’ compensation insurance sector is required.

• Capability to manage claims throughout the litigation process.

• A valid workers’ compensation adjuster license is strongly preferred.

• Must be eligible to obtain additional licenses as required.

• Must pass assigned claims adjuster license exams within 90 days of employment.

• Preference will be given to candidates with experience in multiple state claims management.

• Familiarity with workers’ compensation claims practices, laws, court procedures, precedents, and state statutes.

• Ability to apply logic and reasoning to identify alternative solutions for problem resolution.

• Excellent written and verbal communication skills.

• Strong analytical abilities.

• Capability to multitask and manage time efficiently and effectively.

• Ability to work independently as well as collaboratively in a team setting.

• Develop and maintain strong, effective relationships both internally and externally.

• Function effectively in a paperless environment.

• Proficient in using laptops, claims management systems, and other business-related software including the Microsoft Office suite.

• Candidates may reside in any of Encova’s approved payroll states.

• Must successfully pass required claims adjuster license exams within 90 days of hire.

🏝️ Benefits

• Bonus opportunities.

• Health, Dental & Vision Insurance coverage.

• Company-sponsored life and income protection plans.

• Eligibility to participate in a company incentive bonus program.

• 401(k) Retirement Plan with a 100% company match up to 7% of annual salary.

• Paid Time Off, Paid Holidays, and Floating Holidays.

• Flexible Work Arrangements - Hybrid and remote options based on the role.