Claims Account Specialist

NJM's Workers' Compensation Claims Team is seeking a highly skilled Claims Account Specialist to join our team. This is a full-time position with a hybrid schedule after training.

The Claims Account Specialist will be responsible for contacting all parties involved in the claim, gathering and securing all necessary information to effectively evaluate the claim and implement an action plan to manage the claim.

The ideal candidate will have a strong understanding of workers' compensation laws and regulations, as well as excellent communication and interpersonal skills. They will work closely with policyholders, injured workers, medical providers, and other stakeholders to ensure timely and accurate claim resolution.

Key Responsibilities:

• Execute on strategic and operational goals and objectives of the WCC department and company business goals, guidelines, and programs
• Recommend process improvements where applicable to improve department efficiency, work product, and service commitment to interested parties
• Ensure quality management of claims in accordance with claims best practices and company guidelines, proactive action plans to drive positive return to work results while presenting timely, accurate documentation of claim activity
• Investigate and analyze the loss event, injury, and relevant information to make a compensability determination and recommend a course of action
• Administer the delivery of timely, appropriate, and accurate indemnity and medical benefits
• Provide a high level of customer service that promotes injured worker advocacy-based principles to maximize return to work motivation and improve outcomes for all parties
• Recognize and investigate subrogation opportunity for recovery of third-party funds
• Work with the policyholder and NJM Loss Control to assist and develop stay at work / return to work efforts
• Investigate potential fraud indicators in collaboration with the SIU team
• Initiate and provide excellent communication with all stakeholders (injured workers, providers, attorneys, brokers, clients, etc.) professionally and proactively with a customer-centric approach
• Consistently question and probe all aspects of assigned claims to achieve full understanding of facts
• Comply with, and conduct all activities within state WC claims laws and fair practices, NJM's Code of Ethics, and NJM's Best Practices and Policies
• Build rapport with the policyholder, educate the policyholder on NJM procedures, policies, and claim practices, and evaluate the policyholder's reporting practices
• Include accountability in managing service expectations and rapport and trust with assigned large accounts
• Prepare, attend, and participate in Claim Reviews as needed with the Claims Supervisor
• Participate in training programs to keep current on relevant issues/topics
• Demonstrate a commitment to NJM's 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

Requirements:

• Level I: 3 years' experience as a Workers' Comp Claim Representative, or comparable knowledge and experience with various aspects of claims handling and/or process including basic knowledge of WC Law, medical terminology, and utilization of an automatic claims processing system
• Level II: 35 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 WC Law, medical terminology, and utilization of an automatic claims processing system
• 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 WC Law, medical terminology, and utilization of an automatic claims processing system

Preferred Qualifications:

• Multi-state experience and/or licensing (including NJ, MD, CT, DE, PA and/or NY)
• Associate's or Bachelor's degree
• AIC/CPCU Designations

Salary:

The opportunity can be filled at level I, II, Sr. based on the requirements, experience, and credentials listed above.

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.