Claims Examiner

NJHA HEALTHCARE BUSINESS SOLUTIONS INC•Princeton, NJ

4d•$40,000 - $50,000•Hybrid

About The Position

Reviews simple to complex unemployment insurance claims with input from senior PCM staff. In disputed claims, conducts investigation with input from senior staff, determines if appeal is warranted and follows through with appeals process. Gain knowledge of NJ Unemployment Regulations to efficiently investigate, evaluate and manage all types of UI claims. Reviews/requests separation information/necessary documentation for routine unemployment insurance claims for Address of Record claims. Maintains electronic log of incoming UI forms to ensure timeliness guidelines are met to e-respond. E-responds to the State of NJ via unemployment website. Prepare timely and appropriate file reviews and protest per departmental guidelines. Reviews initial monetary and separation information for non-Address of Record claims to confirm that such information submitted by client are appropriate with respect to state and federal statutes Input/upload all unemployment details into Departmental database. Provides necessary Fact-Finding details/documentation to Unemployment for State DOL to issue Determination of eligibility for benefits. Reviews non-monetary Determinations to ensure determination is accurate based on NJ UI regulations. Based on information received from Division of Unemployment Insurance and from employer, advises employer whether an appeal is warranted. If appeal is filed, follows through with the appeals process. Establishes and maintains claims records to audit charges and initiating protests on charge errors. Maintains follow up files to track responses from employers and NJ Department of Labor. Reviews penalties issued against clients based on review, requests cancellation, abatement or advises client to pay penalty. Develop level of communication with clients and state officials to address all claims issues. Participate in meetings and project activities remotely and in person at worksite. Abides by the terms and conditions of the Confidentiality & Non-Disclosure Agreement. Testifies at hearings when necessary to establish the timeliness of an appeal.

Requirements

High school graduate.
Strong verbal and written communication and problem-solving skills.
Critical thinker and confident decision maker with strong interpersonal and computer skills to include proficiency in spreadsheet software.
Individual should not pose a threat to the health or safety of self or others.

Nice To Haves

Problem solving capabilities
Attention to detail
Time management
Comfortable multitasking

Responsibilities

Reviews simple to complex unemployment insurance claims with input from senior PCM staff.
Conducts investigation in disputed claims with input from senior staff.
Determines if an appeal is warranted and follows through with appeals process.
Gains knowledge of NJ Unemployment Regulations to efficiently investigate, evaluate and manage all types of UI claims.
Reviews/requests separation information/necessary documentation for routine unemployment insurance claims for Address of Record claims.
Maintains electronic log of incoming UI forms to ensure timeliness guidelines are met to e-respond.
E-responds to the State of NJ via unemployment website.
Prepares timely and appropriate file reviews and protest per departmental guidelines.
Reviews initial monetary and separation information for non-Address of Record claims to confirm that such information submitted by client are appropriate with respect to state and federal statutes.
Input/upload all unemployment details into Departmental database.
Provides necessary Fact-Finding details/documentation to Unemployment for State DOL to issue Determination of eligibility for benefits.
Reviews non-monetary Determinations to ensure determination is accurate based on NJ UI regulations.
Advises employer whether an appeal is warranted based on information received from Division of Unemployment Insurance and from employer.
Follows through with the appeals process if an appeal is filed.
Establishes and maintains claims records to audit charges and initiating protests on charge errors.
Maintains follow up files to track responses from employers and NJ Department of Labor.
Reviews penalties issued against clients based on review, requests cancellation, abatement or advises client to pay penalty.
Develops level of communication with clients and state officials to address all claims issues.
Participates in meetings and project activities remotely and in person at worksite.
Abides by the terms and conditions of the Confidentiality & Non-Disclosure Agreement.
Testifies at hearings when necessary to establish the timeliness of an appeal.