Lost Time Claims Specialist – Workers' Compensation

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

📋 Description

• Oversee Workers’ Compensation claims involving lost time and intricate medical-only cases.

• Investigate, assess, and establish compensability regarding work-related injuries and illnesses.

• Analyze and create action plans for medical and indemnity benefits, ensuring cost-effective resolutions.

• Implement established policies, procedures, regulations, and guidelines to determine claim outcomes.

• Conduct interviews and record statements as needed.

• Assess eligibility for indemnity and medical benefits.

• Maintain appropriate case reserves that reflect the likely final claim outcomes.

• Identify, investigate, and pursue subrogation recoveries.

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

• Work collaboratively with injured workers, employers, attorneys, and health and rehabilitation professionals to manage claim expenses and ensure quality care.

• Facilitate a safe and prompt return to work for injured workers.

• Manage claims litigation and oversee panel counsel.

• Analyze reports from physicians, attorneys, and vocational rehabilitation specialists, adjusting claim strategies accordingly.

• Evaluate and negotiate claim settlements.

• Present claim information during internal team staffing and offer guidance.

• Engage in claim reviews, onboarding, meetings, and conferences.

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

⛳️ Requirements

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

• Proven ability to manage claims throughout the litigation process.

• Internal candidates must showcase knowledge of Encova Best Practices and adhere to quality standards.

• One valid workers’ compensation adjuster license is highly preferred.

• Must be eligible to acquire additional required licenses.

• Required to pass the claims adjuster license exam(s) assigned within 90 days of hire.

• Preference may be given to candidates with experience managing claims across multiple states.

• Background in workers’ compensation claims practices, laws, court procedures, precedents, and state statutes.

• Ability to utilize logic and sound reasoning for identifying alternative solutions in problem-solving.

• Excellent written and verbal communication abilities.

• Strong analytical capabilities.

• Proficient in multitasking and managing time efficiently.

• Ability to work independently as well as collaboratively within a team environment.

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

• Capable of working effectively in a paperless environment.

• Proficient in the use of laptops, claims management systems, and standard business software like the Microsoft Office suite.

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

🏝️ Benefits

• 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