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Workers Compensation Claims Representative
2 months ago
We are seeking a highly skilled Workers Compensation Claims Representative to join our team at NJM Insurance Group. As a key member of our claims department, you will be responsible for investigating and analyzing workers' compensation claims, communicating with policyholders and stakeholders, and managing claims to ensure timely and fair resolutions.
Key Responsibilities- Investigate and analyze workers' compensation claims to determine compensability and recommend courses of action.
- Communicate effectively with policyholders, injured workers, medical providers, and other stakeholders to gather information and provide updates on claim status.
- Manage claims from inception to closure, including issuing indemnity payments, monitoring medical treatment, and evaluating the appropriateness of making voluntary offers of partial permanent disability.
- Evaluate claims for potential fraud and escalate files to the Special Investigation Unit as necessary.
- Coordinate with other NJM resources, including WC Medical Services Administration, WC Sales, WC Underwriting, WC SIU, and Legal, to bring special skills to the claim as needed.
- Work with policyholders and NJM Loss Control to develop and implement Early Return to Work (ERTW) programs and evaluate ERTW opportunities to recommend courses of action.
- Build rapport with policyholders, conduct on-site investigations, educate policyholders on NJM procedures, policies, and claim practices, and evaluate policyholder reporting practices.
- Prepare, attend, and conduct Claim Reviews in partnership with the Territory Supervisor.
- Document all actions taken throughout the course of the claim.
- Work experience as a Workers' Compensation Claims Representative or comparable insurance knowledge and experience with various aspects of workers' compensation claims.
- Experience utilizing an automated claim processing system is preferred.
- Excellent communication and interpersonal skills.
- Professional telephone skills and etiquette.
- Strong organizational skills, able to multi-task, detail-oriented, and data entry skills.
- Good decision-making capabilities.
- Experience with the Office 2000 Professional suite of tools (Word, Excel).
- High School Diploma or GED equivalent is required.
- Some travel is required.
- If not already licensed, will be required to obtain Multi-State Licenses after hire.
- Workers Compensation Claims knowledge with an emphasis on NJ.
- Knowledge in additional covered states is a plus.
- Bachelor's Degree is preferred.
- Medical Terminology knowledge is preferred.
- AIC Designation.
- Negotiation Skills.
- Workers Compensation Court Experience.
- Knowledge of OnBase, Claims Center, Guidewire, and/or Xpressions.
- Bi-Lingual Skills are a plus.
NJM Insurance Group is a financially strong and stable company that has flourished on relationships, integrity, and service for over a century. We offer our employees continuous learning options, outstanding benefits, access to wellness programs, and a wide range of opportunities to give back to the communities we serve. Our strategic plan for regional expansion is underway, and we are committed to attracting, retaining, and promoting a diverse and inclusive workforce.
