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.

"You work for NJM? That's a great company!" If you're hired at NJM, you'll hear it over and over again from friends, family and neighbors. Why? Because NJM is committed to providing its customers with superior service, and great service goes a long way. Why else is NJM called a great company? Because our employees enjoy working here, are appreciated, and are provided with a terrific benefits plan. Employees who are hired at NJM often stay at NJM – many for the duration of their careers.

Our Workers’ Compensation Claims Team is seeking two Workers’ Compensation Claims Representatives, 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.

Responsibilities & Assigned Functions
Reporting to the Workers’ Compensation Claims Supervisor, the Workers’ Compensation Claims Representative II (CR 2) is responsible for preparing a complete and thorough investigation on assigned claims that ultimately leads to a compensability decision and a course of action to manage the claim. The incumbent will be responsible for contacting all parties involved in the claim, gathering and securing all necessary information to effectively evaluate the claim and outlining and recommending an action plan to manage the claim. The CR 2 is accountable for the claim results of all assigned claims.
The position will work with and communicate to NJM policyholders, injured workers, medical providers, the NJM Medical Utilization Department, the NJM Special Investigation Unit, WC Legal Staff, and other departments within NJM, as needed.

To accomplish this, the Workers’ Compensation Claims Representative II:

• Reviews, investigates and analyzes loss events, injuries, and coverages to make a compensability determination and plan a course of action.
• Provides excellent communication with policyholders, injured workers, medical providers, brokers, and attorneys during the course of the claim.
• Issues indemnity payments, schedules examinations, monitors medical treatment, and evaluates the appropriateness of making a voluntary offer of partial permanent disability, and all other events relevant to the claim.
• Evaluates the claim for potential fraud and escalate the file to SIU, as appropriate.
• Coordinates with other NJM resources, including but not limited to: WC Medical Services Administration, WC Sales, WC Underwriting, WC SIU, and Legal to bring special skills to the claim as needed.
• Works with the policyholder and NJM Loss Control to assist and develop an Early Return to Work (ERTW) Program, and evaluate the ERTW opportunities to recommend a course of action to the policyholder/injured worker.
• Builds rapport with the policyholder, conduct on-site investigations, and educate the policyholder on NJM procedures, policies, and claim practices.
• Prepares, attends and conducts Claims Reviews, in partnership with the Claims Supervisor.
• Documents all actions taken throughout the course of the claim.
• Complies with, and conducts all activities within, state WC claims laws and fair practices, NJM’s Code of Ethics, and NJM’s Best Practices and Policies.

Required Qualifications and Experience:

• Minimum of 2-5 year’s work experience as a Claim Representative, or comparable insurance knowledge and experience with various aspects of claims handling and /or process.
• Experience utilizing an automated claim processing system.
• Excellent verbal and written communication skills.
• Professional telephone skills/etiquette.
• Strong interpersonal skills.
• Ability to work in a team and independently.
• Valid driver’s license and vehicle.
• Medical terminology knowledge.
• Strong organizational skills and multi-tasking abilities
• Skilled at solving problems.
• Ability to make decisions based on organizational experience / knowledgebase.
• Experience with the Microsoft Office.
• High School Diploma or GED equivalent.
• Some travel.

Preferred:

• College degree
• Bilingual abilities preferred (verbal and/or written)
• Ability to reference evidence-based medical guidelines.
• Negotiation skills
• Experience handling claims from multiple states of jurisdiction including NJ, NY, PA, DE, MD and/or CT.
• Experience handling TPA claims.

Schedule: Monday-Friday, specific hours are subject to selected start time between 8:00am-8:45am pending supervisory approval
Salary Range: $54,000 – $68,000. Salary is commensurate with experience and credentials.

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: $54,000.00 - $68,000.00 per year

Physical setting:

• Office

Schedule:

• Monday to Friday

Work Location: Hybrid remote in Parsippany, NJ 07054

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