Lost Time Claims Specialist - Workers' Compensation
WFA Digital Insight
The demand for skilled Workers' Compensation professionals has grown significantly, with a 25% increase in job postings over the past year. As companies navigate the complexities of remote work, the need for experts who can manage indemnity claims and provide top-notch service has never been more pressing. With its strong reputation in the industry, Encova Insurance is an attractive employer for those looking to make a meaningful impact. Before applying, candidates should be aware that this role requires a deep understanding of Workers' Compensation laws and regulations, as well as excellent analytical and communication skills.
Job Description
About the Role
The Lost Time Claims Specialist role at Encova Insurance is a critical position that involves managing indemnity claims and providing superior service to clients. As a key member of the Workers' Compensation team, the successful candidate will be responsible for investigating, evaluating, and determining the compensability of work-related injury and disease claims. This role requires a unique blend of analytical, communication, and problem-solving skills, as well as the ability to work effectively in a remote environment.The Lost Time Claims Specialist will be part of a dynamic team that is passionate about delivering exceptional results and fostering a culture of continuous improvement. The team is led by an experienced Director, Workers' Compensation Claims, who is committed to supporting the growth and development of all team members. With a strong focus on collaboration and knowledge-sharing, this role offers the opportunity to work with a talented group of professionals who are dedicated to making a positive impact in the industry.
In terms of day-to-day responsibilities, the Lost Time Claims Specialist will be responsible for managing a caseload of indemnity claims, conducting investigations, and making determinations on benefit eligibility. This will involve working closely with clients, medical professionals, and other stakeholders to gather information, analyze data, and make informed decisions. The successful candidate will also be expected to provide guidance and support to junior team members, as well as contribute to the development of best practices and procedures.
What You Will Do
- Evaluate and establish action plans to manage medical and indemnity benefits associated with injury and occupational disease claims
- Conduct investigations and gather facts by conducting interviews with all involved parties
- Determine the outcome of claims using sound judgment and applying established policies, procedures, regulations, and guidelines
- Take recorded statements when necessary
- Determine eligibility of indemnity and medical benefits once salary information and medical treatment plans have been secured and processed
- Utilize proactive reserving behaviors to ensure adequate case reserves
- Identify and develop investigations of subrogation recoveries when possible
- Consult with assigned claim directors, return to work specialists, nurse case managers, internal/external medical, and legal professionals as needed
- Develop and maintain a thorough understanding of Workers' Compensation laws and regulations
- Stay up-to-date with industry trends and best practices
What We Are Looking For
- 2+ years of experience in Workers' Compensation claims handling, with a focus on indemnity claims
- Strong knowledge of Workers' Compensation laws and regulations
- Excellent analytical, communication, and problem-solving skills
- Ability to work effectively in a remote environment and manage a caseload of claims
- Strong organizational and time management skills
- Ability to work collaboratively with clients, medical professionals, and other stakeholders
- Bachelor's degree in a related field (e.g., law, business, healthcare)
- Relevant certifications (e.g., AIC, CPCU) are preferred but not required
Nice to Have
- Experience working with claims management software and systems
- Knowledge of medical terminology and concepts
- Certification in Workers' Compensation claims handling (e.g., WCCP)
- Experience working in a fast-paced, dynamic environment
Benefits and Perks
- Competitive salary and bonus structure
- Comprehensive benefits package, including medical, dental, and vision coverage
- 401(k) retirement plan with company match
- Paid time off and holidays
- Remote work stipend and equipment allowance
- Opportunities for professional development and growth
- Collaborative and supportive work environment
How to Stand Out
- Tip: Be prepared to provide specific examples of your experience handling indemnity claims and working with clients, medical professionals, and other stakeholders.
- Tip: Make sure to highlight your knowledge of Workers' Compensation laws and regulations, as well as your analytical and problem-solving skills.
- Tip: Showcase your ability to work effectively in a remote environment and manage a caseload of claims.
- Tip: Consider obtaining relevant certifications (e.g., AIC, CPCU) to demonstrate your expertise and commitment to the field.
- Tip: Be prepared to discuss your experience with claims management software and systems, as well as your knowledge of medical terminology and concepts.
- Tip: Research the company culture and values to ensure you are a good fit for the role and the organization.
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