Lost Time Claims Specialist,Workers Job Columbus area,Ohio USA,Insurance

Position: Lost Time Claims Specialist, Workers' Compensation

The salary range for this job posting is $55,132.00 - $ annually, plus bonus and benefits.

Pay Type:

Salary

The above represents the full salary range for this job requisition. Ultimately, in determining your pay and job title, we'll consider your location, education, experience, and other job-related factors, and will fall within the stated range. Your recruiter can share more information about the specific salary range during the hiring process.

For candidates residing in certain states such as Illinois, the salary range is $59,630 to $119,670 annually, plus bonus and benefits.

Pay Type:

Salary

We may prefer candidates who can work remote in Illinois, but will consider candidates who live in any of our listed payroll approved states that have the necessary jurisdictional experience.

Lost Time Workers' Compensation claims handling experience in any of the following states:
Illinois, Wisconsin, Kentucky, Indiana, and Iowa is strongly preferred.

The position reports to the Director, Workers' Compensation Claims. We may hire a senior level depending on the candidate's background and experience and the salary range is inclusive of all levels.

JOB OBJECTIVE

The Lost Time Claims Specialist, Workers' Compensation primarily manages indemnity claims. The Lost Time Claims Specialist is responsible for the investigation, evaluation, and determination of compensability for work‑related injury and disease claims following established guidelines to determine benefit eligibility. The Lost Time Claims Specialist also serves as a resource to Medical Only Claims Specialists and Claims Specialist Trainees. The position's objective is to provide superior service in a cost‑effective manner to achieve best possible outcomes as well as proactively collaborate across the enterprise to ensure alignment of objectives and foster continuous improvement.

ESSENTIAL

FUNCTIONS

Evaluates and establishes an action plan to manage medical and indemnity benefits associated with injury and occupational disease claims to their most cost‑effective conclusion.

Decides the outcome of the claim using sound judgment by applying established policy, procedures, regulations and guidelines.

Gathers facts by conducting interviews with all involved parties and considers all the elements of the claim prior to issuing a decision.

Take recorded statements when necessary.

Determines eligibility of indemnity and medical benefits once salary information and medical treatment plans have been secured and processed within the designated authority levels.

Utilize proactive reserving behaviors to ensure adequate case reserves which reflect the probable ultimate outcome based on the current known circumstances throughout the life of the claim.

Actively identifies and develops the investigation of and pursuit of subrogation recoveries when possible.

Consults with assigned claim director, return to work specialists, nurse case managers, internal/external medical, and legal on current and/or recommended treatment, litigation or rehabilitation plans to ensure claims outcomes are achievable and appropriate.

Works collaboratively with the injured worker, employer, outside counsel, and health and rehabilitation professionals to manage the claims costs and promote quality medical care.

Works collaboratively with the injured worker, employer, assigned return to work specialist, and medical providers to facilitate the injured worker's safe and timely return to work.

Manages claims litigation, including expenses, by collaborating and providing direction to panel counsel throughout the life of the claim.

Analyzes reports from external resources such as physicians, attorneys, and/or vocational rehabilitation experts to evaluate and adjust claim strategies as needed.

Evaluates and negotiates claim settlements utilizing human relation skills and technical knowledge to achieve the best possible outcome.

Presents and summarizes claim details at internal team staffing, participates in discussions, and provides guidance as needed.

Consults with assigned claim director if the loss becomes significantly complex or presents significantly increasing financial exposure.

Follows established claims…