Lost Time Claims Specialist, Workers' Compensation
Encova Insurance
Lost Time Claims Specialist, Workers' Compensation
Encova Insurance
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $55,132 - $110,642 per year
Job Level
Mid-LevelSenior
About the role
- The Lost Time Claims Specialist, Workers’ Compensation primarily manages indemnity claims. Responsible for investigation, evaluation, and determination of compensability for work-related injury and disease claims. Provides superior service in a cost-effective manner to achieve best outcomes and collaborate across enterprise. Evaluates and establishes an action plan to manage medical and indemnity benefits associated with injury and occupational disease claims. Decides outcome of claims using established policy, procedures, regulations and guidelines. Gathers facts via interviews and recorded statements when necessary. Determines eligibility of indemnity and medical benefits once salary info and medical treatment plans processed. Utilizes proactive reserving behaviors to ensure adequate case reserves. Identifies and pursues subrogation recoveries when possible. Consults with claim director, return to work specialists, nurse case managers, internal/external medical, and legal. Works collaboratively with injured worker, employer, outside counsel, and health and rehabilitation professionals. Facilitates injured worker’s safe and timely return to work. Manages claims litigation and collaborates with panel counsel. Analyzes reports from external resources to evaluate and adjust claim strategies. Evaluates and negotiates claim settlements. Presents claim details at internal team staffing; participates and provides guidance. Consults with claim director if loss becomes complex or financially exposed. Follows claims best practices related to medical management, litigation, fraud/abuse and recovery. Uses available resources to prioritize, organize, and complete work timely to meet jurisdictional requirements. Develops presentations for special projects. Participates in claim reviews, onboardings, and policyholder/agent interactions. Proactively collaborates with policyholders to ensure alignment and 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. Internal candidates must demonstrate knowledge of Encova Best Practices guidelines and meet quality standards. 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.
