Encova Insurance provides commercial, auto and home insurance.
Lost Time Claims Specialist, Workers' Compensation
Location
Pennsylvania
Posted
9 hours ago
Salary
$55.1K - $110.6K / year
Seniority
Senior
Job Description
Lost Time Claims Specialist, Workers' Compensation
Encova Insurance
• 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. • Takes 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. • Utilizes 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 best practices related to medical management, litigation, fraud/abuse and recovery. • Effectively and independently uses available resources to prioritize, organize, and complete work in a timely manner to meet jurisdictional requirements, timeframes, and internal metrics. • Develops presentations for special projects such as internal/external meetings and conferences as needed. • Participates in claim reviews, onboardings, etc. for our policyholders and agents. • Proactively collaborates with our policyholders to ensure alignment of objectives and foster continuous improvement.
Job 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.
- One valid workers’ compensation adjuster license is strongly preferred.
- 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 multitask 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.
Benefits
- Health, Dental & Vision Insurance
- Company-provided life and income protection plans
- Eligibility to participate in a company incentive bonus program
- 401(k) Retirement Plan - 100% company match up to 7% on annual salary
- Paid Time Off, Paid Holidays, and Floating Holidays
- Flexible Work Arrangements - Hybrid and remote depending on the role
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