NJM’s Workers’ Compensation Claims Team is seeking a Claim Account Specialist. This is a full-time position and offers a hybrid schedule after training.
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, the NJM Medical Services Administration Department, the NJM Special Investigation Unit, WC Legal Staff, other departments within NJM, and vendors as needed.
This role is based in NJM’s- West Trenton, NJ office location.
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
Required Qualifications and Experience:
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%
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
Salary: The opportunity can be filled at level I, II, Sr. based on the requirements, experience, and credentials listed above.
Level I - $48K - $56K annually based on experience and credentials
Level II - $55K+ annually based on experience and credentials
Sr Level - $73K+ annually based on experience and credentials
Legal Disclaimer: 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.
