Lost Time Claims Specialist, Workers

The salary range for this job posting is $55,132.00 - $ annually + bonus + benefits. The actual salary range for candidates who reside in Pennsylvania is $59, annually + bonus + benefits. We strongly prefer candidates who reside in Pennsylvania; however, we will consider candidates who reside in any of our listed payroll approved states.

This Lost Time Claims Specialist, Workers’ Compensation manages indemnity claims, investigates, evaluates, and determines compensability for work‑related injury and disease claims. The role supports Medical Only Claims Specialists and Claims Specialist Trainees and collaborates across the enterprise to achieve superior service and cost‑effective outcomes.

• Develop actionable plans to manage medical and indemnity benefits for injury and occupational disease claims to cost‑effective conclusions.
• Apply established policy, procedures, regulations, and guidelines to decide claim outcomes.
• Gather facts through interviews with all involved parties and consider all claim elements before issuing a decision.
• Record statements when necessary.
• Determine eligibility of indemnity and medical benefits within designated authority levels.
• Use proactive reserving behaviors to ensure adequate case reserves that reflect probable ultimate outcomes.
• Identify and pursue subrogation recoveries when possible.
• Consult with claim directors, return‑to‑work specialists, nurse case managers, internal/external medical and legal teams on treatment, litigation, or rehabilitation plans.
• Collaborate with injured workers, employers, outside counsel, and health and rehabilitation professionals to manage claims costs and promote quality medical care.
• Facilitate safe and timely return to work for injured workers.
• Manage claims litigation, including expenses, by guiding panel counsel throughout the life of the claim.
• Analyze external resource reports to evaluate and adjust claim strategies.
• Negotiate claim settlements to achieve the best possible outcomes.
• Present and summarize claim details at internal staffing meetings and provide guidance as needed.
• Escalate complex losses or those with significant financial exposure to the claim director.
• Follow best practices related to medical management, litigation, fraud/abuse, and recovery.
• Prioritize, organize, and complete work in a timely manner to meet jurisdictional and internal metrics.
• Develop presentations for special projects, internal and external meetings, and conferences.
• Participate in claim reviews, onboarding, and other policyholder and agent related activities with the claim director, regional vice president, and other claims staff.
• Collaborate proactively with policyholders to align objectives and foster continuous improvement.

• Perform other duties as assigned.

• Bachelor’s Degree from an accredited college or university is preferred.
• Three years of experience in 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.
• Must pass the claims adjuster license exam(s) within 90 days of being hired.
• Preferred candidates have experience in multiple state claims management.
• Experience with workers’ compensation claims practices, laws, court procedures, precedents, and state statutes.
• Strong analytical, written, and verbal communication skills.
• Ability to use logic and sound reasoning to identify alternative solutions for problem‑solving.
• Ability to multitask and manage time effectively.
• Works effectively independently and in a team environment.
• Develops and maintains strong internal and external relationships.
• Works efficiently in a paperless environment.
• Skilled in the use of laptops, claims management systems, and standard business programs such as Microsoft Office.

• Health, Dental & Vision Insurance
• Company‑provided life and income protection plans
• Incentive bonus program participation
• 401(k) Retirement Plan – 100% company match up to 7% of annual salary
• Paid Time Off, Paid Holidays, and Floating Holidays
• Flexible Work Arrangements – Hybrid and remote depending on the role

Encova Insurance makes every effort to reasonably accommodate disabilities to permit performance of the essential functions. Candidates who need such accommodation are encouraged to seek it. Encova Insurance is an EOE/E-Verify employer.