Lost Time Claims Specialist – Workers' Compensation

🔥 0 minutes ago

🦌 Connecticut, Florida, +21 more states – Remote

🦌 Connecticut – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote 🌾 Nebraska – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote

💵 $55.1k - $110.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 Ghost score 0%

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Encova Insurance

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🛡️ Insurance

💸 Finance

👥 B2C

Insurance • Finance • B2C

Encova Insurance is an insurance company dedicated to providing comprehensive insurance solutions for both personal and commercial needs. With decades of experience in the industry, Encova Insurance offers a wide range of products including home, auto, and workers' compensation insurance, while specializing in tailored commercial packages for complex businesses. They prioritize innovation and customer service, ensuring policyholders receive the support and coverage necessary for long-term success.

📋 Description

• Manage indemnity and medical workers’ compensation claims through cost-effective resolution. • Investigate, evaluate, and determine compensability of work-related injury and occupational disease claims. • Establish action plans for medical and indemnity benefits. • Apply policies, procedures, regulations, and guidelines to determine claim outcomes and benefit eligibility. • Conduct interviews and take recorded statements when necessary. • Secure and process salary information and medical treatment plans within designated authority levels. • Maintain adequate case reserves based on probable claim outcomes. • Identify and pursue subrogation recoveries. • Consult with claim directors, return-to-work specialists, nurse case managers, medical professionals, and legal counsel. • Collaborate with injured workers, employers, counsel, and healthcare and rehabilitation professionals to manage costs and promote quality care. • Facilitate safe and timely return to work. • Manage claim litigation and direct panel counsel. • Analyze reports from physicians, attorneys, and vocational rehabilitation experts. • Evaluate and negotiate claim settlements. • Present claim details at internal team staffing and provide guidance. • Escalate significantly complex claims or increasing financial exposure. • Follow claims best practices for medical management, litigation, fraud/abuse, and recovery. • Prioritize and complete work according to jurisdictional requirements, timeframes, and internal metrics. • Develop presentations for special projects, meetings, and conferences. • Participate in claim reviews, onboardings, and policyholder and agent activities. • Collaborate with policyholders to align objectives and foster continuous improvement.

🎯 Requirements

• Bachelor’s Degree from an accredited college or university is preferred. • Three years of experience in the field of workers’ compensation insurance required. • Ability to manage claims through the litigation process. • One valid workers’ compensation adjuster license is strongly preferred. • Must be eligible to obtain additional licenses as required. • Must pass the claims adjuster license exam(s) as assigned within 90 days of being hired. • Preference may be shown to candidates with multiple state claims management experience. • Experience in workers’ compensation claims practices and laws, court procedures, precedents and state statutes. • Ability to use logic and sound reasoning to identify alternative solutions for problem-solving. • Strong written and verbal communication skills. • Strong analytical skills. • Ability to multitasks and manage time effectively and productively. • Work effectively independently as well as in a team environment. • Develop and maintain strong, effective internal and external relationships. • Work effectively in a paperless environment. • Skilled in the use of laptops, claims management systems, and other typical business-related programs such as Microsoft Office suite. • Candidates may reside in any of Encova’s listed payroll approved states. • Must pass required claims adjuster license exams within 90 days of hire.

🏖️ 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 - 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