- Execute 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 through proactive execution of action plans to resolve claim and legal issues and 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.
- Administer the delivery of timely, appropriate, and accurate indemnity and medical benefits.
- 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.
- 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 escalate 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.
- 3-5 years' work experience as a NJ Workers' Comp Claim Representative with an emphasis on legal knowledge.
- Basic 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.
- Strong interpersonal skills with ability to work both in a team setting and independently.
- Demonstrated organizational skills and use of sound decision-making capabilities.
- Strong 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%.
- Experience in completing settlement evaluations (S20/OAS).
- Multi-state experience and/or licensing (including NJ, MD, CT, DE, PA and/or NY).
- Associate or Bachelor's degree.
- AIC/CPCU Designations.
-
Claims Resolution Specialist
1 week ago
NJM Insurance Group Hammonton, United States Full timeJob 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 Spe ...
-
Issue Resolution Specialist
1 week ago
Independence Blue Cross Philadelphia, United StatesOur organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable wh ...
-
Accounts Resolution Specialist II
2 weeks ago
Penn Medicine Philadelphia, United StatesDescription · Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with ...
-
Accounts Resolution Specialist I
4 days ago
Pennsylvania Medicine Philadelphia, United StatesPenn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, ...
-
Accounts Resolution Specialist II
6 days ago
Pennsylvania Medicine Philadelphia, United StatesPenn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, ...
-
Accounts Resolution Specialist II
1 week ago
Pennsylvania Medicine Philadelphia, United StatesPenn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, ...
-
Accounts Resolution Specialist II
2 weeks ago
Penn Medicine Philadelphia, United States**Description** · Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration w ...
-
Igaming Support Supervisor
1 week ago
Parx Casino Moorestown, United StatesAssists the Customer Service Manager with training, support, and administration of the team. Acts as escalation point for iGaming Support Specialists and Lead iGaming Support Specialists. Performs the duties of the Customer Service Manager in their absence. · - Ensure attainment ...
-
HRis Specialist
2 days ago
Cooper University Health Care Camden, United States**About us** · At Cooper University Health Care, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technol ...
-
Case Manager
12 hours ago
Intealth Philadelphia, United StatesWe are looking to hire a full-time **Case Manager and Client Support Specialist** within our EPIC Client Services department at Intealth. The EPIC Case Manager & Client Support Specialist serves as a liaison between ECFMG and assigned Clients utilizing ECFMG's primary source veri ...
-
Medical Billing/business Office Manager
1 week ago
Shore Orthopaedic University Associates Somers Point, United StatesJob Summary: · Orthopaedic Surgical Practice located in coastal NJ, is seeking a Full-Time Medical Billing /Business Office Manager to provide supervisory oversight of all facets of the billing and collections department including claims processing, accounts receivable and revenu ...
-
Property Inspector
1 week ago
Associa Mount Laurel, United StatesJob Summary · A Code Enforcement Specialist plays an active role in achieving long-term customer satisfaction in · the context of Community Association relationships. Specific responsibilities will vary with · designated communities and may include, but are not limited to: Inspec ...
-
Community Engagement Specialist
3 days ago
Graduate Philadelphia Philadelphia, United States: · Job Title: Community Engagement Specialist (North10) · Location: North North 10th Street, Philadelphia, PA 19140 · Department: Programming and Innovation · FLSA Status: Full Time Exempt · **General Description** · The Community Engagement Specialist maintains all community ou ...
-
Aml Advisor
1 week ago
TD Bank Mount Laurel, United StatesWork Location: · Mount Laurel, New Jersey · Hours: · 40 · Pay Details: · $86,840 - $139,369 USD · Line of Business: · Anti Money Laundering · **Job Description**: · The AML Advisor provides expert/specialize advice to portfolios, businesses and functions on development and mainte ...
-
Computer Repair Specialist
12 hours ago
Worldgate, llc Philadelphia, United States**JOB SUMMARY**: · The Technical Service Production Support Specialist will work on-site at a support center fixing computer hardware devices such as Chromebook computers. This position will coordinate with the technical support center (TSC) staff to ensure computer devices are o ...
-
Customer Enrollment Representative
2 days ago
ACQ Inc. Moorestown, United StatesDue to increased demand, we are expanding throughout the Philadelphia and South Jersey area. We proudly work alongside some of the most recognized brands in the country. Our job is to assist in the acquisition and enrollment of new customers. We pride ourselves on the work that w ...
-
Transition Project Manager
1 week ago
Paycom Payroll Llc Philadelphia, United StatesThis position has a starting salary of $62,500 per annum with an uncapped commission plan. Paycom provides employees health insurance at an employee cost of $1 per-pay-period, a 401(k) plan with company match, available flexible spending accounts, $50,000 basic life and AD&D, pai ...
-
24-25 Sy School Counselor
5 days ago
The School District Of Philadelphia Philadelphia, United States**24-25 SY School Counselor - Elem School Counselor K-6** **-** **(** **)** · **Description** · **Job Summary**: · Provides counseling services that foster the academic, personal, social, and career development of all students. Provides individual/group counseling and guidance fo ...
-
Operations Associate
1 week ago
Fabric Health Philadelphia, United States**About Fabric Health**: · Since our inception in 2021, we've been at the forefront of social impact, recognized by Fast Company and Forbes for our exceptional service to thousands of families. We're on a mission to change the way families access healthcare and public benefits, a ...
-
Billing Specalist
1 week ago
Alliance Cancer Specialists Philadelphia, United StatesOverview: · **THIS IS NOT A REMOTE POSITION.** · **Top Reasons To Work for Alliance Cancer Specialists**: · Comprehensive benefits package for full-time employees including: · Medical, Dental, Vision, Life, and Disability insurance · 401k Plan · Paid Time Off · Highly competitive ...
Claims Resolution Specialist - Hammonton, United States - New Jersey Manufacturers Insurance Company
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.
Preferred:
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.
