Workers Comp Rep, Senior

<p><strong>Personal, compassionate service is what we'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></p>

West Trenton, NJ

NJM Insurance Group

<strong>Insurance is our business. Service is our passion. That's what sets us apart in an industry whose most important job is to be there for people when they need us most. Our commitment to customer satisfaction is repeatedly recognized by leading, independent consumer publications, which rate us as providing among the best service in the country. Founded by customers for customers, at our core, we&rsquo;re simply people devoted to helping people.<br /><br />The last thing you need after you file a claim is a long wait for answers. Rest assured in knowing that NJM is repeatedly recognized for outstanding claim satisfaction in leading consumer surveys, the results of which are based entirely on customer feedback. We also performed well in a consumer report from the New Jersey Department of Banking and Insurance.<br /></strong> https://www.njm.com/

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Professional

Overview: <span style="display: inline !important; float: none; font-family: Roboto; font-size: 14px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">The position will work with and communicate to NJM policyholders, injured workers, medical providers, the NJM Medical Services Administration Department, the NJM Special Investigation Unit, WC Legal Staff, and other departments within NJM, as well as outside defense counsel and vendors needed.&nbsp;&nbsp;</span><span style="display: inline !important; float: none; font-family: Roboto; font-size: 14px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">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 Claim Representative is accountable for the claim results of all assigned claims.</span>
Responsibilities: <ul> <li>Investigates and analyzes the loss event, the injury, and the relevant information to make a compensability determination and recommend a course of action.</li> <li>Initiates and provides excellent communication with all stakeholders during the course of the claim.</li> <li>Manages the claim, which includes the issuance of indemnity payments, monitoring the medical treatment, evaluating&nbsp; the appropriateness of making a voluntary offer of partial permanent disability,&nbsp; and all other events relevant to the claim</li> <li>Evaluates the claim for potential fraud and escalates the file to SIU, as appropriate.</li> <li>Coordinates with other NJM resources, including but not limited to:&nbsp; 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, educate the policyholder on NJM procedures, policies, and claim practices to which they should adhere, and evaluate the policyholder&rsquo;s reporting practices.</li> <li>Prepares, attends and conducts Claim Reviews, in partnership with the Territory Supervisor.</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>3-5 years&rsquo; work experience as a Workers' Comp Multi-State Claim Representative, or comparable insurance knowledge and experience with various aspects of Workers' Comp claims handling and/or process preferred.</li> <li>Experience utilizing an automated claim processing system preferred.</li> <li>Excellent 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>Good organizational skills, able to multi-task, detail oriented, and data entry skills.</li> <li>Good decision making capabilities.</li> <li>Experience with the Office 2000 Professional suite of tools (Word, Excel).</li> <li>High School Diploma or GED equivalent is required</li> <li>Some travel is required</li> </ul>