Workers Comp Rep, Senior

<strong>Personal, compassionate service is what we&rsquo;re known for at NJM. We seek the best and brightest to help our customers when they need us most. As part of the NJM team, you'll not only enjoy some of the best benefits in the industry, you'll also be joining a company that's committed to professional development, diversity and innovative thinking.</strong><br /><br /><strong>What is it like to work at NJM?&nbsp; Click <a href=";feature=emb_logo" target="_blank" title="Video" rel="noopener noreferrer">here</a> to see!<br /><br />If you don't see the position you are looking for, apply <a href="" target="_blank" title="Introduce Yourself" rel="noopener noreferrer">here</a>.<br /></strong>

Parsippany Trenton Hammonton

NJM Insurance

<p><strong>This isn&rsquo;t just insurance.&nbsp; It&rsquo;s NJM.</strong></p> <p>When you join the NJM family, you&rsquo;ll work with talented people who care about doing the right thing by our policyholders as well as each other. You&rsquo;ll be part of a financially strong and stable company that has flourished on relationships, integrity and service for more than a century. NJM is a special place where you can propel your career, help others and make friends &ndash; all at the same time.&nbsp;</p> <p>NJM is proud to 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 are privileged to serve.&nbsp;</p> <p>Leading, independent consumer publications repeatedly recognize our commitment to customer and claims satisfaction. In addition, NJM has been named to the Forbes list of the Best Employers in New Jersey three years in a row, based on feedback directly from our employees.</p>

keywords: position summary,work environment,claims,medical,analysis,communication,performance,build,assist,control,experience,skills,education,schedule,teamwork,travel,knowledge


Overview: <p>"You work for NJM? That's a great company!" If you're hired at NJM, you'll hear it over and over again from friends, family and neighbors. Why? Because NJM is committed to providing its customers with superior service, and great service goes a long way. Why else is NJM called a great company? Because our employees enjoy working here, are appreciated, and are provided with a terrific benefits plan. Employees who are hired at NJM often stay at NJM &ndash; many for the duration of their careers.</p> <p>Our Workers&rsquo; Compensation Claims Team is seeking a Workers&rsquo; Compensation Sr. Claims Representative. This is a full-time position and offers a hybrid schedule after training, working from home 3 days per week.</p> <p>This role can be based in any of our three New Jersey office locations: West Trenton, Hammonton or Parsippany.</p>
Responsibilities: <p>Reporting to the Workers&rsquo; Compensation Claims Supervisor, the Workers&rsquo; Compensation Claims Representative SR. &nbsp;(CR SR.) is responsible for independently preparing a complete and thorough investigation on assigned claims that ultimately leads to a compensability decision and a course of action to manage the claim.&nbsp; The incumbent will be responsible for contacting all parties involved in the claim, gathering and securing all necessary information to effectively evaluate the claim and outlining and recommending an action plan to manage the claim.&nbsp; The CR Sr. &nbsp;is accountable for the claim results of all assigned claims.</p> <p>The position will work with and communicate to NJM policyholders, injured workers, medical providers, the NJM Medical Utilization Department, the NJM Special Investigation Unit, WC Legal Staff, and other departments within NJM, as needed.&nbsp;</p> <p><strong>To accomplish this, the Workers&rsquo; Compensation Claims Representative Sr.:</strong></p> <p>&nbsp;</p> <ul> <li>Reviews, investigates and analyzes loss events, injuries, and coverages to make a compensability determination and plan a course of action.</li> <li>Provides excellent communication with policyholders, injured workers, medical providers, brokers, and attorneys during the course of the claim.</li> <li>Issues indemnity payments, schedules examinations, monitors medical treatment, and evaluates the appropriateness of making a voluntary offer of partial permanent disability, and all other events relevant to the claim.</li> <li>Evaluates the claim for potential fraud and escalate the file to SIU, as appropriate.</li> <li>Coordinates with other NJM resources, including but not limited to: WC Medical Services Administration, WC Sales, WC Underwriting, WC SIU, and Legal to bring special skills to the claim as needed.</li> <li>Works with the policyholder and NJM Loss Control to assist and develop an Early Return to Work (ERTW) Program, and evaluate the ERTW opportunities to recommend a course of action to the policyholder/injured worker.</li> <li>Builds rapport with the policyholder, conduct on-site investigations, and educate the policyholder on NJM procedures, policies, and claim practices.</li> <li>Prepares, attends and conducts Claims Reviews in partnership with Claim Supervisor.</li> <li>Mentors and assists in the training of CR 1 and CR 2.</li> <li>Covers for the Claims Supervisor when he/she is out of the office or attending meetings.</li> <li>Documents all actions taken throughout the course of the claim.</li> <li>Complies with, and conducts all activities within, state WC claims laws and fair practices, NJM&rsquo;s Code of Ethics, and NJM&rsquo;s Best Practices and Policies.</li> </ul>
Requirements: <ul> <li>Minimum of 3-5 year&rsquo;s work experience as a Claim Representative, or comparable insurance knowledge and experience with various aspects of claims handling and /or process.</li> <li>Experience utilizing an automated claim processing system.</li> <li>Excellent verbal and written communication skills.</li> <li>Professional telephone skills/etiquette.</li> <li>Strong interpersonal skills.</li> <li>Ability to work in a team and independently.</li> <li>Valid driver&rsquo;s license and vehicle.</li> <li>Medical terminology knowledge.</li> <li>Strong organizational skills and multi-tasking abilities</li> <li>Skilled at solving problems.</li> <li>Ability to make decisions based on organizational experience / knowledgebase.</li> <li>Experience with the Microsoft Office.</li> <li>High School Diploma or GED equivalent.</li> <li>Some travel.</li> </ul> <br /><strong>Preferred:</strong><br /> <ul> <li>College degree</li> <li>AIC Designation</li> <li>Bilingual abilities preferred (verbal and/or written)</li> <li>Ability to reference evidence-based medical guidelines.</li> <li>Negotiation skills</li> <li>Experience handling claims from multiple states of jurisdiction including NJ, NY, PA, DE, MD and/or CT.</li> <li>Experience handling TPA claims.</li> <li>Knowledge of OnBase, ClaimsCenter, Guidewire and/or xPressions.</li> </ul> <br /><strong>Schedule:</strong> Monday-Friday, specific hours are subject to selected start time between 8:00am-8:45am pending supervisory approval.<br /><br /><strong>Salary Range:</strong> $71,000 - $83,000. Salary is commensurate with experience and credentials.