Lost Time Claims Specialist, Workers' Compensation

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

📋 Description

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

• Conduct investigations, assessments, and establish compensability for claims related to work-related injuries and illnesses

• Assess and formulate action plans for both medical and indemnity benefits

• Make determinations on claim outcomes based on established policies, procedures, regulations, and guidelines

• Collect facts through interviews and, when necessary, obtain recorded statements

• Assess eligibility for indemnity and medical benefits

• Maintain sufficient case reserves that accurately reflect potential claim outcomes

• Identify and pursue recoveries through subrogation

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

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

• Facilitate the safe and timely return to work for injured employees

• Manage litigation related to claims, associated expenses, and work with panel counsel

• Review and analyze reports from physicians, attorneys, and vocational rehabilitation specialists

• Evaluate and negotiate settlements for claims

• Present claim information during internal team meetings and offer guidance

• Adhere to best practices in claims management concerning medical oversight, litigation, fraud prevention, and recovery processes

• Prioritize and complete tasks to meet jurisdictional standards, timelines, and internal metrics

• Create presentations for special projects and meetings

• Engage in claim reviews, onboarding, and activities involving policyholders and agents

• Collaborate actively with policyholders to align goals and promote continuous improvement

⛳️ Requirements

• Candidates may reside in any of the states approved for payroll

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

• Capability to manage claims throughout the litigation process

• A Bachelor’s Degree from an accredited institution is preferred

• Possession of at least one valid workers’ compensation adjuster license is strongly preferred

• Must be qualified to obtain additional licenses as necessary

• Required to pass the claims adjuster license examination(s) as assigned within 90 days of employment

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

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

• Ability to apply logic and sound reasoning to identify alternative solutions for problem-solving

• Excellent written and verbal communication skills

• Strong analytical capabilities

• Proficient in multitasking and managing time efficiently and productively

• Ability to work effectively both independently and as part of a team

• Develop and sustain strong, effective relationships internally and externally

• Function effectively in a paperless environment

• Proficient with laptops, claims management systems, and the Microsoft Office suite

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

🏝️ Benefits

• Bonus

• Health, Dental & Vision Insurance

• Company-sponsored life and income protection plans

• Eligibility to take part 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