Lost Time Claims Specialist, Workers' Compensation

The salary range for this job posting is $55,132.00 - $110,642.00 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.

While we may prefer candidates who can work a hybrid schedule in our Charleston, WV office, we will consider candidates who live in any of our listed payroll approved states.

Lost Time Workers' Compensation claims handling experience in Virginia, West Virginia, Kentucky, or Pennsylvania is preferred.

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

Are you a Referral?

If you know a current Encova Insurance associate and would like to apply as a referral, please encourage them to submit your referral information before you submit your application. You will receive an email with a direct URL link to the Job Posting of interest. Applying through this URL link will create your referral relationship for our Talent Acquisition Team.

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.

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:  
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 physicians, attorneys, and/or vocational rehabilitation experts to evaluate and adjust claim strategies as needed.   
13.    Evaluates and negotiates claim settlements utilizing human relation skill