Lost Time Claims Specialist, Workers' Compensation

🔥 14 hours ago

🦌 Connecticut, Florida, +21 more states – Remote

🦌 Connecticut – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – 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 🍑 Georgia – Remote

💵 $55.1k - $110.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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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 Workers’ Compensation lost time and complex medical-only claims • Investigate, evaluate, and determine compensability for work-related injury and disease claims • Evaluate and establish action plans for medical and indemnity benefits • Decide claim outcomes using policies, procedures, regulations, and guidelines • Gather facts through interviews and take recorded statements when necessary • Determine eligibility of indemnity and medical benefits • Maintain adequate case reserves reflecting 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 injured workers’ safe and timely return to work • Manage claims litigation, expenses, and 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 • Follow claims best practices for medical management, litigation, fraud/abuse, and recovery • Prioritize and complete work to meet jurisdictional requirements, timeframes, and internal metrics • Develop presentations for special projects and meetings • Participate in claim reviews, onboardings, and policyholder and agent activities • Collaborate proactively with policyholders to align objectives and foster continuous improvement

🎯 Requirements

• Candidates may live in any of our listed payroll approved states • Three years of experience in the field of workers’ compensation insurance required • Ability to manage claims through the litigation process • Bachelor’s Degree from an accredited college or university is preferred • 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 multitask 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 Microsoft Office suite • Internal candidates must demonstrate knowledge of Encova Best Practices guidelines and meet quality standards

🏖️ 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

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