Lost Time Claims Specialist, Workers' Compensation

Encova Insurance

. Manage Workers’ Compensation lost time and complex medical-only claims .

Posted 11/11/2026full-timeRemote • United StatesMid-LevelSenior💰 $55,132 - $110,642 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing Workers’ Compensation claims, including evaluating compensability, negotiating settlements, and ensuring compliance with regulations. Proficient in collaborating with various stakeholders to facilitate effective claims management and promote quality care for injured workers.

Highest-signal resume keywords

Workers’ Compensation Claims ManagementClaims Litigation ProcessWorkers’ Compensation Adjuster LicenseAnalytical SkillsStrong Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims EvaluationCompensability DeterminationMedical Benefits AssessmentIndemnity Benefits EligibilityClaims Settlement NegotiationSubrogation RecoveryCase Reserve ManagementClaims Best PracticesLegal ComplianceProblem-Solving

Soft Skills

Time ManagementMultitaskingTeam CollaborationRelationship BuildingEffective Communication

Tools & Technologies

Claims Management SystemsMicrosoft Office SuitePaperless Environment

Certifications & Qualifications

Workers’ Compensation Adjuster License

Industry Keywords

Workers’ Compensation InsuranceCourt ProceduresState StatutesMedical ManagementFraud Prevention

About the role

Key responsibilities & impact

Manage Workers’ Compensation lost time and complex medical-only claims
Investigate, evaluate, and determine compensability for work-related injury and disease claims
Evaluate and establish action plans for medical and indemnity benefits
Decide claim outcomes using policies, procedures, regulations, and guidelines
Gather facts through interviews and take recorded statements when necessary
Determine eligibility of indemnity and medical benefits
Maintain adequate case reserves reflecting probable claim outcomes
Identify and pursue subrogation recoveries
Consult with claim directors, return-to-work specialists, nurse case managers, medical professionals, and legal counsel
Collaborate with injured workers, employers, counsel, and healthcare and rehabilitation professionals to manage costs and promote quality care
Facilitate injured workers’ safe and timely return to work
Manage claims litigation, expenses, and panel counsel
Analyze reports from physicians, attorneys, and vocational rehabilitation experts
Evaluate and negotiate claim settlements
Present claim details at internal team staffing and provide guidance
Follow claims best practices for medical management, litigation, fraud/abuse, and recovery
Prioritize and complete work to meet jurisdictional requirements, timeframes, and internal metrics
Develop presentations for special projects and meetings
Participate in claim reviews, onboardings, and policyholder and agent activities
Collaborate proactively with policyholders to align objectives and foster continuous improvement

Requirements

What you’ll need

Candidates may live in any of our listed payroll approved states
Three years of experience in the field of workers’ compensation insurance required
Ability to manage claims through the litigation process
Bachelor’s Degree from an accredited college or university is preferred
One valid workers’ compensation adjuster license is strongly preferred
Must be eligible to obtain additional licenses as required
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
Skilled in the use of laptops, claims management systems, and Microsoft Office suite
Internal candidates must demonstrate knowledge of Encova Best Practices guidelines and meet quality standards

Benefits

Comp & perks

Bonus
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