Sr.)

NJM Insurance Group•Hammonton, NJ

5d•Hybrid

About The Position

The Workers Compensation team is searching for a WC Claims Account Specialist (I/II/Sr). The overall responsibility of this position is to consistently execute on the Company’s mission vision values, leading customer service approach, and claims business model that leads to better outcomes for our injured workers and insureds. The Claims Account Specialist will be responsible for contacting all parties involved in the claim, gathering, and securing all necessary information to effectively evaluate the claim and implement an action plan to manage the claim. The Claims Account Specialist will work with and communicate to NJM policyholders, injured workers, medical providers, NJM Medical Services Administration Department, the NJM Special Investigation Unit, WC Legal Staff, other departments within NJM, and vendors as needed. This is an entry level position in the Claims Account track that will require consistent supervision, guidance and coaching in the skill development of the role. Hours Monday-Friday, specific hours are subject to selected start time between 8am-9am pending supervisory approval. Hybrid opportunity after training is completed (3 days in office, 2 days remote) Essential Duties and Responsibilities: Essential functions of this job are listed below in order of priority. Reasonable accommodations may be made to enable individuals to perform the essential duties. Regular and predictable onsite attendance is an essential function of the job. Execute on strategic and operational goals and objectives of the WCC department and company business goals, guidelines, and programs Recommend process improvements where applicable to improve department efficiency, work product, and service commitment to interested parties Ensure quality management of claims in accordance with claims best practices and company guidelines, proactive action plans to drive positive return to work results while presenting timely, accurate documentation of claim activity Investigate and analyze the loss event, injury, and relevant information to make a compensability determination and recommend a course of action Administer the delivery of timely, appropriate, and accurate indemnity and medical benefits Provide a high level of customer service that promotes injured worker advocacy-based principles to maximize return to work motivation and improve outcomes for all parties Recognize and investigate subrogation opportunity for recovery of third-party funds Work with the policyholder and NJM Loss Control to assist and develop stay at work / return to work efforts Investigate potential fraud indicators in collaboration with the SIU team Initiate and provide excellent communication with all stakeholders (injured workers, providers, attorneys, brokers, clients, etc.) professionally and proactively with a customer-centric approach Consistently question and probe all aspects of assigned claims to achieve full understanding of facts Comply with, and conduct all activities within state WC claims laws and fair practices, NJM’s Code of Ethics, and NJM’s Best Practices and Policies Build rapport with the policyholder, educate the policyholder on NJM procedures, policies, and claim practices, and evaluate the policyholder’s reporting practices Include accountability in managing service expectations and rapport and trust with assigned large accounts Prepare, attend, and participate in Claim Reviews as needed with the Claims Supervisor Participate in training programs to keep current on relevant issues/topics 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

Requirements

Level I - 0-3 years’ experience as a Workers' Comp Claim Representative, or comparable knowledge and experience with various aspects of claims handling and/or process including basic knowledge of WC Law, medical terminology, and utilization of an automatic claims processing system.
Level II - 3-5 years’ experience as a Workers' Comp Claim Representative, or comparable knowledge and experience with various aspects of claims handling and/or process including strong knowledge of WC Law, medical terminology, and utilization of an automatic claims processing system.
Sr Level – 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 WC Law, medical terminology, and utilization of an automatic claims processing system.
Ability to manage return to work expectations with employers, doctors, and injured workers
Strong written and oral communication skills with ability to work both in a team setting and independently
Sound decision-making and critical thinking capabilities
Demonstrated organizational and communication skills
Superior customer service skills and ability to engage in business interactions with a polite, courteous, and professional manner
Working knowledge of Microsoft Office suite of tools (Word, Excel)
Ability to travel for business purposes, approximately less than 10%
High school diploma or GED equivalent

Nice To Haves

Multi-state experience and/or licensing (including NJ, MD, CT, DE, PA and/or NY)
Associate or bachelor’s degree
AIC/CPCU Designations

Responsibilities

Execute on strategic and operational goals and objectives of the WCC department and company business goals, guidelines, and programs
Recommend process improvements where applicable to improve department efficiency, work product, and service commitment to interested parties
Ensure quality management of claims in accordance with claims best practices and company guidelines, proactive action plans to drive positive return to work results while presenting timely, accurate documentation of claim activity
Investigate and analyze the loss event, injury, and relevant information to make a compensability determination and recommend a course of action
Administer the delivery of timely, appropriate, and accurate indemnity and medical benefits
Provide a high level of customer service that promotes injured worker advocacy-based principles to maximize return to work motivation and improve outcomes for all parties
Recognize and investigate subrogation opportunity for recovery of third-party funds
Work with the policyholder and NJM Loss Control to assist and develop stay at work / return to work efforts
Investigate potential fraud indicators in collaboration with the SIU team
Initiate and provide excellent communication with all stakeholders (injured workers, providers, attorneys, brokers, clients, etc.) professionally and proactively with a customer-centric approach
Consistently question and probe all aspects of assigned claims to achieve full understanding of facts
Comply with, and conduct all activities within state WC claims laws and fair practices, NJM’s Code of Ethics, and NJM’s Best Practices and Policies
Build rapport with the policyholder, educate the policyholder on NJM procedures, policies, and claim practices, and evaluate the policyholder’s reporting practices
Include accountability in managing service expectations and rapport and trust with assigned large accounts
Prepare, attend, and participate in Claim Reviews as needed with the Claims Supervisor
Participate in training programs to keep current on relevant issues/topics
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

Benefits

Eligible full-time employees receive a competitive Total Rewards package, including but not limited to a 401(k) with employer match up to 8% and additional service-based contributions, Health, Dental, and Vision insurance, Life and Disability coverage, generous PTO, Paid Sick Leave, and paid parental leave in addition to state-mandated leave.
Employees may also be eligible for discretionary bonuses.

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