Lost Time Claims Specialist, Workers' Compensation

The salary range for this job posting is $55,132.00 - $ annually + bonus + 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. We will consider candidates who reside in any of our listed payroll approved states with the related experience.

This role will manage Workers' Compensation Lost Time and Medical Only claims within multiple jurisdictions, which includes but not limited to Virginia and New England territory. Ideal candidates will have experience managing Workers' Comp claims in Massachusetts, Rhode Island or New Hampshire. We may hire a senior level depending on the candidate's background and experience and the salary range is inclusive of all levels.

The position reports to the Director, Workers' Compensation Claims.

Unique residence requirements are listed in each job posting, please review closely for details.

Encova is only able to employ associates who reside and work within specific U.S. states. Our current policies are based on the laws in states in which we are registered for payroll. Our current footprint includes:
Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, Wisconsin.

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.

• 1. 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.
• 2. Decides the outcome of the claim using sound judgment by applying established policy, procedures, regulations and guidelines.
• 3. Gathers facts by conducting interviews with all involved parties and considers all the elements of the claim prior to issuing a decision.
• 4. Take recorded statements when necessary.
• 5. Determines eligibility of indemnity and medical benefits once salary information and medical treatment plans have been secured and processed within the designated authority levels.
• 6. 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.
• 7. Actively identifies and develops the investigation of and pursuit of subrogation recoveries when possible.
• 8. 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.
• 9. Works collaboratively with the injured worker, employer, outside counsel, and health and rehabilitation professionals to manage the claims costs and promote quality medical care.
• 10. 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.
• 11. Manages claims litigation, including expenses, by collaborating and providing direction to panel counsel throughout the life of the claim.
• 12. Analyzes reports from external resources such as…