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New Jersey WC Claims Adjustor 1

3 months ago

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Company Overview:

The Enlyte Family of Businesses

Mitchell | Genex | Coventry

Enlyte is the parent brand of Mitchell, Genex and Coventry, an organization unlike any other in the Property & Casualty industry, bringing together three great businesses with a shared vision of using technology innovation, clinical services and network solutions to help our customers and the people they serve. Our suite of products and services enable our employees to help people recover from challenging life events, while providing opportunities for meaningful impact and career growth.

Job Description:

This position is a hybrid role and you must reside in New Jersey as this position has potential to return partially to the office.

  • Contacts the employer and medical provider or Nurse Case Manager upon receipt of claim to confirm/secure details of the New Jersey Workers Compensation claim.
  • Contacts employees when required and provides timely and accurate information to employer.
  • Determines if the claim is compensable in accordance with the applicable legal jurisdiction.
  • Identifies the treating physician to confirm the nature and extent of the injury. Refers to treating physicians in connection with or in lieu of Nurse Case Manager.
  • Oversees medical treatment and communicates to employer.
  • Completes all state required forms pursuant to applicable jurisdiction requirements.
  • Sets appropriate reserves to pay medical treatment on accepted claims.
  • Prepares and provides medical bills for repricing to the approved MCO (Managed Care Organization) vendor, where applicable.
  • Obtain approval for medical treatment payment consistent with client protocols.
  • Accurately and efficiently pay medical bills related to claim.
  • Maintains appropriate Medical Only diary, pursuant to our Best Practices.


Qualifications:

Minimum Education:

High School Diploma or Equivalent

Associates Degree Preferred

Required Skills and Experience:

1-2 Years Workers' Compensation Claims Experience

Microsoft Excel and Word

Desired Skills and Experience:

Medical Terminology

Written Communication Skills

Benefits:
Were committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. Benefits eligibility may differ depending on full-time or part-time status. Compensation depends on the applicable US geographic market. The expected base pay for this position ranges from $18.45 - $19.23 hourly, and will be based on a number of additional factors including skills, experience, and education.

The Company is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.

Dont meet every single requirement? Studies have shown that women and underrepresented minorities are less likely to apply to jobs unless they meet every single qualification. We are dedicated to building a diverse, inclusive, and authentic workplace, so if youre excited about this role but your past experience doesnt align perfectly with every qualification in the job description, we encourage you to apply anyway. You may be just the right candidate for this or other roles.

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