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.

NJM’s Workers’ Compensation Claims Team is seeking a Claim Resolution Specialist, Level II.

This is a full-time position and offers a hybrid schedule after training, working from home 3 days per week.

This role can be based in any of our three New Jersey office locations: West Trenton, Hammonton or Parsippany.

Schedule: Monday-Friday, specific hours are subject to selected start time between 8:00am-8:45am pending supervisory approval.

Salary Range: $62,000 - $78,000. Salary is commensurate with experience and credentials.

Job Description
The Claim Resolution Specialist II 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 Claim Resolution Specialist II 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 as needed. This role will manage litigated claims of mid to high complexity while developing deeper knowledge of legal approaches and negotiation skills to take on higher value cases.

Responsibilities

• Execute on strategic and operational goals and objectives of the WCC department and company business goals, guidelines, and programs
• Recommend process improvement where applicable to best improve the department efficiency, work product, and service commitment to interested parties
• Manage workers’ compensation claims with proactive execution of action plans to resolve claim and legal issues to move cases toward closure
• Ensure quality management of claims in accordance with claims best practices and company guidelines, and timely, accurate documentation of claim activity
• Work with NJM Legal to resolve the claim within given authority
• Determine compensability and coverage issues that have been placed in litigation by gathering medical and factual evidence
• Apply critical thinking skills to establish a strategic plan of action, evaluate and mitigate exposure and negotiate and resolve claims
• Authorize and issue indemnity payments and evaluate the appropriateness of making a voluntary offer of partial permanent disability (PPD)
• Develop a litigation plan with NJM Legal to control legal expenses and assure effective resolution of claims to reduce aged inventory
• Work closely with NJM Legal on litigated cases, and attend mediation, settlement conferences, and hearings as necessary to resolve issues and close cases
• Contact and engage with plaintiff law firms to bring resolution to the case inclusive of dismissals and settlements
• Assist in the preparation of Medicare Set Asides (MSA) and annuity products to fund settlements to maximize their value
• Maintain knowledge of new and existing relevant laws and regulations, taking appropriate action to ensure timely compliance and communication to appropriate departments
• Evaluate the claim for potential fraud indicators and escalates the file to SIU, as appropriate
• Coordinate with other NJM resources to successfully resolve and/or settle cases in a timely fashion
• 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

• 5-8 years’ work experience as a NJ Workers' Comp Claim Representative with an emphasis on legal knowledge
• Demonstrated knowledge of legal approaches, terminology, and applicable case law
• Customer service oriented with strong written and oral communication skills and ability to work both in a team setting and independently
• Critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details
• Experience in deciding compensability issues, inclusive of medical causal relationship, and completing settlement evaluations (S20/ OAS)
• Strong interpersonal skills with ability to work both in a team setting and independently
• Demonstrated organizational skills and use of sound decision-making capabilities
• Proficient knowledge utilizing an automated claim processing system and the Microsoft Office suite of tools (Word, Excel)
• Ability to travel for business purposes, approximately less than 10%

Preferred:

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

Legal Disclaimer: NJM is proud to be an equal opportunity employer. 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.

Job Type: Full-time

Pay: $62,000.00 - $78,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off

Schedule:

• Monday to Friday

Application Question(s):

• Will you be able to reliably commute to one of NJM's New Jersey offices in West Trenton, Hammonton or Parsippany for this job? If so, please list which location you are interested in.
• Please indicate your desired annual salary (Note: responses of N/A, negotiable, or left blank will not be considered)

Work Location: Hybrid remote in West Trenton, NJ 08628

Please Note :
www.bankofmontserrat.ms is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, www.bankofmontserrat.ms provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.