Workers Compensation Adjuster Based in Parsippany, NJ

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Parsippany, NJ

NJM Insurance Group

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keywords: prepare,claims,analysis,communication,reporting,medical,build,claims,control,communication,experience,skills,compensation,knowledge,education,teamwork

Full Time

Overview: <p>Reporting to the Workers' Compensation Claims Territory Supervisor, the Workers&rsquo; Compensation Claim Representative will be based in our Parsippany, NJ location and is responsible for 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. 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. The Claim Representative 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 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. The Claim Representative will prepare, attend, and conduct Claim Reviews in partnership with the Territory Supervisor.</p>
Responsibilities: <strong>To accomplish this, the Workers&rsquo; Compensation Claim Representative:</strong><br /> <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, conducts on-site investigations, educates 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 are 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 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> <li>If not already licensed will be required to obtain Multi-State Licenses after hire</li> </ul> Preferred:<br /> <ul> <li>Workers Compensation Claims knowledge with an emphasis on NJ</li> <li>Knowledge in additional covered states is a plus. Additional covered States include MD, CT, DE, PA and/or NY.</li> <li>Bachelor&rsquo;s Degree is preferred</li> <li>Medical Terminology knowledge is preferred</li> <li>AIC Designation</li> <li>Negotiation Skills</li> <li>Workers Compensation Court Experience</li> <li>Knowledge of OnBase, Claims Center, Guidewire and/or Xpressions</li> <li>Bi-Lingual Skills are a plus</li> </ul>