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Claims Resolution Specialist (Workers' Compensation Claims) - Hammonton
Location:
Hammonton, NJ
Description:
Job Description The Claim Resolution Specialist 1 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 1 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. In coordination with the Claim Resolution Supervisor, make recommendations for medical, voluntary offers of permanent partial disability (PPD), and seek authority as needed. This role will manage litigated claims of low complexity for further development within this track.This role can be based in any of NJM's New Jersey office locations: West Trenton, Hammonton, or Parsippany. Responsibilities: Execute on strategic and operational goals and objectives of the WCC department and company business goals, guidelines, and programsRecommend process improvement where applicable to best improve the department efficiency, work product, and service commitment to interested partiesManage workers' compensation claims through proactive execution of action plans to resolve claim and legal issues and move cases toward closureEnsure quality management of claims in accordance with claims best practices and company guidelines, and timely, accurate documentation of claim activityWork with NJM Legal to resolve the claim within given authorityDetermine compensability and coverage issues that have been placed in litigation by gathering medical and factual evidenceApply critical thinking skills to establish a strategic plan of action, evaluate and mitigate exposure and negotiate and resolve claimsAdminister the delivery of timely, appropriate, and accurate indemnity and medical benefitsDevelop a litigation plan with NJM Legal to control legal expenses and assure effective resolution of claims to reduce aged inventoryWork closely with NJM Legal on litigated cases, and attend mediation, settlement conferences, and hearings as necessary to resolve issues and close casesContact and engage with plaintiff law firms to bring resolution to the case inclusive of dismissals and settlementsMaintain knowledge of new and existing relevant laws and regulations, taking appropriate action to ensure timely compliance and communication to appropriate departmentsEvaluate the claim for potential fraud indicators and escalates the file to SIU, as appropriateCoordinate with other NJM resources to successfully resolve and/or settle cases in a timely fashionPrepare, attend, and participate in Claim Reviews as needed with the Claims SupervisorParticipate in training programs to keep current on relevant issues/topicsDemonstrate 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: 3-5 years' work experience as a NJ Workers' Comp Claim Representative with an emphasis on legal knowledgeBasic knowledge of legal approaches, terminology, and applicable case lawCustomer service oriented with strong written and oral communication skills and ability to work both in a team setting and independentlyCritical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to detailsExperience in deciding compensability issues, inclusive of medical causal relationshipStrong interpersonal skills with ability to work both in a team setting and independentlyDemonstrated organizational skills and use of sound decision-making capabilitiesStrong 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: Experience in completing settlement evaluations (S20/ OAS)Multi-state experience and/or licensing (including NJ, MD, CT, DE, PA and/or NY)Associate's or Bachelor's degreeAIC/CPCU Designations Salary Range: $55,000 - $70,000. Salary is commensurate with experience and credentials.This role may be filled at a Level II or Senior level based on skills, 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.PDN-9be780cc-23fe-4a5d-904c-c26f5a956743
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More About this Listing: Claims Resolution Specialist (Workers' Compensation Claims) - Hammonton
Claims Resolution Specialist (Workers' Compensation Claims) - Hammonton is a Other Jobs Claims Resolution Specialist Job at NJM Insurance Group located in Hammonton NJ. Find other listings like Claims Resolution Specialist (Workers' Compensation Claims) - Hammonton by searching Oodle for Other Jobs Claims Resolution Specialist Jobs.
Claims Resolution Specialist (Workers' Compensation Claims) - Hammonton is a Other Jobs Claims Resolution Specialist Job at NJM Insurance Group located in Hammonton NJ. Find other listings like Claims Resolution Specialist (Workers' Compensation Claims) - Hammonton by searching Oodle for Other Jobs Claims Resolution Specialist Jobs.