Lost Time Claims Specialist, Workers' Compensation

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

📋 Description

• Oversee Workers’ Compensation Lost Time and Medical Only claims across various jurisdictions

• Investigate, assess, and decide on the compensability of work-related injury and disease claims

• Develop action plans and ascertain eligibility for medical and indemnity benefits

• Collect information through interviews and, when necessary, record statements

• Set and maintain appropriate case reserves based on likely claim outcomes

• Identify and pursue subrogation recoveries

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

• Work in coordination with injured workers, employers, legal counsel, and healthcare and rehabilitation experts to manage costs and ensure quality care

• Facilitate a safe and prompt return to work

• Oversee claim litigation and direct panel counsel

• Analyze external medical, legal, and vocational reports and adjust claim strategies accordingly

• Evaluate and negotiate claim settlements

• Present claim details during internal team meetings and offer guidance

• Participate in claim reviews, onboarding sessions, meetings, and special projects

• Collaborate with policyholders to align goals and promote continuous improvement

• Report directly to the Director of Workers’ Compensation Claims

⛳️ Requirements

• Minimum of three years of experience in the workers’ compensation insurance field is required

• Capability to manage claims through the litigation process

• Knowledge of workers’ compensation claims practices and laws, court procedures, precedents, and state statutes

• Excellent written and verbal communication skills

• Strong analytical abilities

• Proficient in multitasking and effectively managing time

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

• Develop and sustain strong, effective relationships both internally and externally

• Comfortable working in a paperless environment

• Proficient in using laptops, claims management systems, and business applications such as the Microsoft Office suite

• Bachelor’s Degree from an accredited college or university is preferred

• A valid workers’ compensation adjuster license is strongly preferred; must be eligible to obtain additional licenses as required

• Must successfully pass the claims adjuster license exam(s) assigned within 90 days of hire

• Preference may be given to candidates with multi-state claims management experience

• Internal candidates must demonstrate knowledge of Encova Best Practices guidelines and meet quality standards

• Candidates must reside and work in an approved U.S. payroll state; preference for Pennsylvania candidates, with relevant experience required for other states listed

🏝️ 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 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 available depending on the role