Sr. Workers Compensation Claims Specialist

New Jersey Manufacturers•Parsippany, CT

14h•Remote

About The Position

NJM’s WC Claims Department is seeking an experienced Sr. Workers Compensation Claims Specialist who lives in or near Connecticut to provide on-site service to our policyholders and agents in that state. This is a 100% remote position which includes virtual claims handling for customers in any area of CT and possibly MD, DE or PA as needed. At NJM, our WC Claims Department empowers our employees to focus on delivering guidance and empathy to our customers. As a department driven by service and customer advocacy, we are committed to providing transparent, empathetic support and collaborative engagement during the life of a claim. The WC Claims Department takes pride in being a key component in the growth and success of our policyholders’ business operations. To meet these expectations, WC Claims Specialists are supported by a dedicated call center who can field calls for them and other specialized units who are responsible for setting reserves, making permanency payments, and following through on subrogation so they can dedicate the time needed to manage claims. Many of our staff are long-tenured with a focus on building relationships, not only with our customers, but with each other providing a positive and nurturing work environment.

Requirements

5+ years’ experience as a Workers' Comp Claim Representative, or comparable knowledge and experience with various aspects of claims handling and/or process including advanced knowledge of medical terminology and WC regulations for CT claims.
Knowledge of and/or experience working with liens and Medicare Set-Asides to secure full and final settlements
Customer service oriented with strong written and oral communication skills
Strong interpersonal skills with ability to work both in a team and independently
Demonstrated organizational skills, and use of sound decision-making capabilities
Working knowledge utilizing an automated claim processing system and Microsoft Office tools including Word and Outlook
Licensed in CT to adjust WC claims.
Ability to travel for business purposes, approximately 2 – 3 days a week meeting with policyholders and/or agents

Nice To Haves

Associate or bachelor’s degree
AIC/CPCU or other applicable insurance designations
Experience using Guidewire Claim Center, OnBase and additional Microsoft Office tools including Teams, Excel and PowerPoint
Knowledge and experience in WC claims handling in various states including PA, MD and/or DE.
Licensed in other states including DE to adjust WC claims.

Responsibilities

Ensure quality management of claims in accordance with claims best practices and company guidelines, and timely, accurate documentation of claim activity
Provide a high level of customer service that promotes injured worker advocacy-based principles to improve outcomes for all parties
Determine compensability and coverage issues by gathering medical and factual evidence
Administer the delivery of timely, appropriate, and accurate benefits
Evaluate the claim for potential fraud indicators and escalate the claim to SIU, as appropriate
Recognize and investigate subrogation opportunity and refer to NJM subrogation staff for recovery of third-party funds
Initiate and provide excellent communication with all stakeholders (injured workers, medical providers, attorneys, policyholders, agents, etc.) professionally and proactively with a customer-centric approach
Apply critical thinking skills to evaluate and mitigate exposures, and establish and implement a proactive strategic plan of action
Assign and refer claim petitions to Counsel, and work to resolve the claim within given authority
Build rapport with policyholders and agents, conduct on-site investigations when necessary, and educate policyholders and agents on NJM procedures, policies, and claim practices
Prepare and attend Claim Reviews at policyholder or agent locations in CT or virtually for further locations.
Serve as a liaison between policyholders/agents and various departments in NJM.
Represent WC Claim in on-site capabilities meetings to onboard new policyholders in CT.
Participate in training programs to keep current on relevant issues/topics
Recommend process improvement where applicable to best improve the department efficiency, work product, and service commitment to interested parties
Demonstrate a commitment to NJM’s Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards, and laws applicable to job responsibilities in the performance of work