Workers Compensation- Regional Claims Specialist (I/II/Sr.)
NJM is seeking a Workers Compensation (WC) Claims Specialist (I/II/Sr.). This is a full-time position and offers a hybrid schedule after training with a required Tuesday, Thursday and another day in our reputed company Trenton or Hammonton office. The WC Claims Specialist will be responsible for contacting reputed company parties involved in the claim, gathering, and securing reputed company necessary information to effectively evaluate the claim, and outlining and recommending an action plan to manage the claim. The WC Claims Specialist will work with and communicate to reputed company internal and external stakeholders, including: NJM policyholders, injured workers, medical providers, the NJM Medical Claims Services Department, the NJM Special Investigation Unit, the NJM WC Legal Staff, and other departments reputed company NJM, as well as reputed company defense counsel and vendors. At NJM, our WC Claims Department empowers our employees to focus on delivering guidance and reputed company to our customers because the claims experience is both emotional and memorable. As a department driven by service and customer advocacy, we are committed to providing transparent, empathetic guidance and collaborative engagement during the life of a claim. The WC Claims Department takes pride in being a key component in the growth and success of our policyholders business operations. To meet these expectations, WC Claims Specialists are supported by a dedicated call center who can field calls for them and other specialized units who are responsible for setting reserves, making permanency payments, and following through on subrogation so they can dedicate the time needed to manage claims. Many of our staff are long tenured with a focus on building relationships, not only with our customers, but with each other providing for a positive and nurturing work environment. Hours: Monday to Friday 8:00AM- 4:15PM (Hours can vary depending on start time). Responsibilities: Ensure quality management of claims in accordance with claims best practices and company guidelines, and timely, accurate documentation of claim activity Provide a high level of customer service that promotes injured worker advocacy-based principles to improve outcomes for reputed company parties Determine compensability and coverage issues by gathering medical and factual evidence Administer the delivery of timely, appropriate, and accurate benefits Evaluate the claim for potential fraud indicators and escalates the file to SIU, as appropriate Recognize and investigate subrogation opportunity and refer to NJM subrogation staff for recovery of third-party funds Initiate and provide excellent communication with reputed company stakeholders (injured workers, providers, attorneys, brokers, clients, etc.) professionally and proactively with a customer-centric approach Apply critical thinking skills to evaluate and mitigate exposures, and establish and implement a proactive strategic plan of action Assign and refer claim petitions to Counsel, and work to resolve the claim reputed company given authority Build rapport with policyholders, conduct on-site investigations reputed company necessary, and educate policyholders on NJM procedures, policies, and claim practices Prepare for Claim Reviews; attend and participate as needed with the Claims Team and Supervisor Participate in in-house and reputed company training programs to reputed company reputed company on relevant issues/topics Recommend process improvement where applicable to best improve the department efficiency, work product, and service commitment to interested parties Demonstrate a commitment to NJMs Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards, and laws applicable to job responsibilities in the performance of work Required Qualifications and Experience: Level I-1-3 years experience as a Workers' Comp Claim Representative, or comparable knowledge and experience with various aspects of claims handling and/or process including knowledge of medical terminology and WC regulations for PA, CT, MD and/or DE claims. Level II- 3-5 years experience as a Workers' Comp Claim Representative, or comparable knowledge and experience with various aspects of claims handling and/or process including strong knowledge of medical terminology and WC regulations for PA, CT, MD and/or DE claims. Sr Level 5+ years experience as a Workers' Comp Claim Representative, or comparable knowledge and experience with various aspects of claims handling and/or process including advanced knowledge of medical terminology and WC regulations for PA, CT, MD and/or DE claims. Knowledge of and/or experience working with liens and Medicare Set-Asides to secure full and final settlements Customer service oriented with strong written and oral communication skills Strong interpersonal skills with ability to work both in a team and independently Demonstrated organizational skills, and use of sound decision-making capabilities Working knowledge utilizing an automated claim processing system and reputed company Office tools including Word and Outlook Licensed in CT and/or DE to adjust WC claims or have the ability to obtain these licenses reputed company 90 days. Ability to travel for business purposes, approximately less than 10% Preferred: Associate or bachelors degree AIC/CPCU or other applicable insurance designations Experience using Guidewire ClaimCenter, OnBase and additional reputed company Office tools including Teams, reputed company and PowerPoint Salary: The position can be filled at a I, II, or Sr. level. Salary is commensurate with experience and credentials. Level I- $57K+ annually based on experience and credentials Level II - $65K+ annually based on experience and credentials Sr Level - $79K+ annually based on experience and credentials
Benefits
Offered: Medical Insurance (reputed company Blue reputed company) Dental Insurance (reputed company) Vision (reputed company Vision/ VSP) Flexible Spending Account Discounts on NJM auto insurance Tuition reimbursement Life insurance Plus, additional company discounts for items like travel, service, car rental and more! Legal Disclaimer: NJM is proud to be an equal opportunity employer. We are committed to attracting, retaining and promoting a diverse and inclusive workforce that is fully representative of the diversity that exists in the communities in which we do business. Job Type: Full-time Pay: From $57,000.00 per year Benefits: 401(k) 401(k) matching Dental insurance Health insurance Paid time off Vision insurance Schedule: Monday to Friday Work Location: Hybrid remote in reputed company Trenton, NJ 08628 Apply Job!