Lost Time Claims Specialist, Workers' Compensation

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Assesses and formulates a strategic action plan to oversee medical and indemnity benefits linked to injury and occupational disease claims, ensuring a cost-effective resolution.

• Determines claim outcomes using informed judgment in accordance with established policies, procedures, regulations, and guidelines.

• Collects relevant information by interviewing all parties involved and evaluates all aspects of the claim before making a decision.

• Takes recorded statements when necessary.

• Establishes eligibility for indemnity and medical benefits after securing and processing salary information and medical treatment plans within designated authority levels.

• Employs proactive reserving practices to maintain sufficient case reserves that reflect the likely final outcome based on current known factors throughout the claim's duration.

• Proactively identifies and develops investigations into subrogation recoveries whenever feasible.

• Collaborates with the assigned claim director, return to work specialists, nurse case managers, and both internal and external medical and legal professionals regarding current or recommended treatment, litigation, or rehabilitation strategies to ensure achievable and appropriate claims outcomes.

• Works in partnership with the injured worker, employer, external counsel, and health and rehabilitation experts to manage claim costs while promoting quality medical care.

• Collaborates with the injured worker, employer, return to work specialist, and medical providers to support the safe and timely return of the injured worker to their job.

• Oversees claims litigation, including associated expenses, by coordinating and guiding panel counsel throughout the claim's lifecycle.

• Analyzes reports from external sources such as physicians, attorneys, and vocational rehabilitation experts to assess and modify claim strategies as necessary.

• Evaluates and negotiates claim settlements, leveraging interpersonal skills and technical expertise to achieve optimal outcomes.

• Presents and summarizes claim information during internal team staffing, contributing to discussions and providing guidance as required.

• Consults with the assigned claim director when a loss becomes considerably complex or poses significant financial exposure.

• Adheres to established claims best practices concerning medical management, litigation, fraud/abuse, and recovery.

• Efficiently and independently utilizes available resources to prioritize, organize, and complete work in a timely manner to meet jurisdictional requirements, deadlines, and internal performance metrics.

• Prepares presentations for special projects, including internal and external meetings and conferences as needed.

• Engages in claim reviews, onboarding sessions, etc., for our policyholders and agents.

• Actively collaborates with our policyholders to ensure alignment of objectives and promote continuous improvement.

⛳️ Requirements

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

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

• Proven ability to manage claims through the litigation process.

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

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

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

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

• Strong logical reasoning and problem-solving skills.

• Excellent written and verbal communication abilities.

• Strong analytical capabilities.

• Ability to multitask and manage time effectively and efficiently.

• Capability to work independently as well as collaboratively in a team environment.

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

• Proficient in working in a paperless environment.

🏝️ 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