Workers’ Compensation Claims Representative

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.

Parsippany, New Jersey

NJM Insurance Group

<p><strong>Come Grow with Us!</strong></p> <p>&nbsp;</p> <p>For more than a century, our policyholders have trusted us to serve them in their times of need. For just as long, we have supported our employees by providing a competitive compensation package and opportunities for growth. If you are looking to be part of something special and make a difference each day, we invite you to come grow with us. There's never been a better time to join the NJM family.&nbsp;</p> <h3>This isn't just insurance.&nbsp;&nbsp;<strong>It's NJM</strong><strong>.<br /><br /><br /></strong>If you don't see the job you're looking for below, please click <a href=";cws=47" target="_blank" rel="noopener noreferrer">here</a> to create a search agent, or log in to check the status of your previous application.&nbsp;</h3> <h3><em><strong>&nbsp;</strong></em></h3>

keywords: claims,communication,reporting,claims,medical,communication,experience,license,teamwork,organization,communication,travel

Full Time

Overview: Reporting to the WC Claims Supervisor, the Workers’ Compensation Claims Representative I is responsible for monitoring the medical treatment and claim results on No Time Loss (NTL) claims that are assigned through ClaimCenter or by the Claims Supervisor. A WC Claims Representative will also manage Time Loss (TL) claims under the direction of their supervisor and is responsible for following up on modified duty, responding to all inquiries regarding medical treatment and temporary disability benefits. The Representative will be responsible for contacting all parties involved in the claim and gathering and securing all necessary information to be in a position to bring a NTL claim to conclusion, or discuss and handle TL claims with their Supervisor’s support. The Claim Representative I is accountable for the claim results of all assigned claims.This position will be based in our Parsippany office. The position will work under the direction of the Claims Supervisor in communicating with NJM policyholders, injured workers, medical providers, the WC Medical Services Administration department, the NJM Special Investigation Unit, WC Legal Staff, and other departments within NJM.
Responsibilities: Job Responsibilities: <br /> <ul> <li>Reviews, investigates and analyzes loss events, injuries and coverages to make a compensability decision and plan a course of action with the supervisor. Provides excellent communication with policyholders, injured workers, medical providers, brokers, and attorneys during the course of the claim. Reviews NTL claims and authorize appropriate medical treatment. Manages the claim, which includes, monitoring the medical treatment, responding to all inquiries, updating the policyholder on claim status, maintaining contact with the injured worker and documenting all actions taken throughout the course of the claim on all claims assigned to them. Under the direction of the Claims Supervisor, issues indemnity payments, evaluates the appropriateness of making a voluntary offer of partial permanent disability, and discusses all other events relevant to claims assigned to them. Partners with a Claim Rep 2, a Sr Claim Rep or Claims Supervisor on visits to policyholders, if needed. Utilizes NJM resources and coordinate with other NJM departments, including, but not limited to, WC Medical Services Administration, WC Sales, WC Underwriting, WC SIU, Legal, to bring special skills to the claim as needed. 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: Required Qualifications and Experience: <br /> <ul> <li>0-3 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>Excellent verbal and written communication skills 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 Strong organizational skills and multi-tasking abilities</li> <li>Skilled at solving problems Ability to make decisions based on organizational experience / knowledgebase</li> <li>Experience with the Office 2010 Professional suite of tools (Word, Excel) High School Diploma or GED equivalent</li> <li>Some travel Preferred: College degree Knowledge of Workers&rsquo; Compensation claims</li> </ul> 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.