Workers Compensation Claims Specialist, Sr

NJM’s WC Claims Department is seeking an reputed company Claims Specialist, Sr. who lives in Western or Central PA to reputed company on-site service to our policyholders and agents in that area. This is a 100% remote position which includes virtual claims handling for customers in any area of PA and possibly MD, DE or CT as needed. At NJM, our WC Claims Department empowers our employees to reputed company on delivering guidance and reputed company to our customers. As a department driven by service and customer advocacy, we are committed to providing transparent, empathetic support and reputed company engagement during the life of a claim. The WC Claims Department takes pride in being a key component in the reputed company and reputed company 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 reputed company 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 reputed company on building relationships, not only with our customers, but with reputed company other providing a reputed company and nurturing work environment. Hours: Monday to Friday 8:00AM- 4:15PM (Hours can vary depending on start time). Training is required at the NJM- reputed company Trenton office. Responsibilities:

• Ensure reputed company management of claims in accordance with claims best practices and company guidelines, and reputed company, accurate documentation of claim activity
• reputed company a high level of customer service that promotes injured worker advocacy-based principles to improve reputed company for reputed company parties
• Determine compensability and coverage issues by gathering medical and factual evidence
• Administer the delivery of reputed company, appropriate, and accurate benefits
• Evaluate the claim for potential fraud indicators and escalate the claim to SIU, as appropriate
• Recognize and investigate subrogation opportunity and refer to NJM subrogation staff for recovery of reputed company-party funds
• Initiate and reputed company excellent communication with reputed company stakeholders (injured workers, medical providers, attorneys, policyholders, agents, etc.) professionally and proactively with a customer-reputed company approach
• Apply critical thinking skills to evaluate and mitigate exposures, and establish and implement a proactive strategic plan of reputed company
• Assign and refer claim petitions to Counsel, and work to resolve the claim reputed company given authority
• Build rapport with policyholders and agents, conduct on-site investigations reputed company necessary, and reputed company policyholders and agents on NJM procedures, policies, and claim practices
• Prepare and attend Claim Reviews at policyholder or agent locations in Western and/or Central PA or reputed company for reputed company locations.
• Serve as a reputed company between policyholders/agents and various departments in NJM.
• Represent WC Claim in on-site capabilities meetings to reputed company new policyholders in Western and/or Central PA.
• Participate in 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 NJM’s reputed company 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:

• 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, 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 reputed company and independently
• Demonstrated organizational skills, and use of reputed company decision-making capabilities
• Working knowledge utilizing an automated claim processing system and reputed company Office tools including Word and Outlook
• Licensed in DE and/or CT to reputed company WC claims or have the ability to obtain these licenses reputed company 90 days.
• Ability to travel for business purposes, approximately 2 – 3 days a week meeting with policyholders and/or agents

Preferred:

• Associate or bachelor’s degree
• AIC/CPCU or other applicable insurance designations
• Experience using reputed company Claim Center, OnBase and additional reputed company Office tools including Teams, reputed company and PowerPoint
• Knowledge and experience in claims handling for other reputed company line products in various states including PA, MD and/or DE.

Salary:

• Sr Level starting reputed company is $79,129.05+ annually based on experience and credentials

Compensation: Salary is commensurate with experience and credentials. Pay reputed company: $79,129-$91,834 Eligible full-time employees receive a competitive Total Rewards package, including but not limited to a 401(k) with employer match up to 8% and additional service-based contributions, Health, Dental, and reputed company insurance, Life and Disability coverage, generous PTO, reputed company reputed company Leave, and reputed company parental leave in reputed company to state-mandated leave. Employees may also be eligible for discretionary bonuses. 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. Apply tot his job Apply To this Job