Claim Account Specialist (I/II/ Sr.)

NJM Insurance Group is seeking a Claims Account Specialist (I/II/Sr) to join their Workers Compensation team. This role involves managing claims by gathering necessary information, evaluating claims, and implementing action plans while providing excellent customer service and ensuring compliance with relevant laws and practices.ResponsibilitiesExecute on strategic and operational goals and objectives of the WCC department and company business goals, guidelines, and programsRecommend process improvements where applicable to improve department efficiency, work product, and service commitment to interested partiesEnsure 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 activityInvestigate and analyze the loss event, injury, and relevant information to make a compensability determination and recommend a course of actionAdminister the delivery of timely, appropriate, and accurate indemnity and medical benefitsProvide a high level of customer service that promotes injured worker advocacy-based principles to maximize return to work motivation and improve outcomes for all partiesRecognize and investigate subrogation opportunity for recovery of third-party fundsWork with the policyholder and NJM Loss Control to assist and develop stay at work / return to work effortsInvestigate potential fraud indicators in collaboration with the SIU teamInitiate and provide excellent communication with all stakeholders (injured workers, providers, attorneys, brokers, clients, etc.) professionally and proactively with a customer-centric approachConsistently question and probe all aspects of assigned claims to achieve full understanding of factsComply with, and conduct all activities within state WC claims laws and fair practices, NJM’s Code of Ethics, and NJM’s Best Practices and PoliciesBuild rapport with the policyholder, educate the policyholder on NJM procedures, policies, and claim practices, and evaluate the policyholder’s reporting practicesInclude accountability in managing service expectations and rapport and trust with assigned large accountsPrepare, 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 workSkillsLevel 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 systemLevel 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 systemSr 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 systemAbility to manage return to work expectations with employers, doctors, and injured workersStrong written and oral communication skills with ability to work both in a team setting and independentlySound decision-making and critical thinking capabilitiesDemonstrated organizational and communication skillsSuperior customer service skills and ability to engage in business interactions with a polite, courteous, and professional mannerWorking knowledge of Microsoft Office suite of tools (Word, Excel)Ability to travel for business purposes, approximately less than 10%High school diploma or GED equivalentMulti-state experience and/or licensing (including NJ, MD, CT, DE, PA and/or NY)Associate or bachelor's degreeAIC/CPCU DesignationsBenefits401(k) with employer match up to 8% and additional service-based contributionsHealth, Dental, and Vision insuranceLife and Disability coverageGenerous PTOPaid Sick LeavePaid parental leave in addition to state-mandated leaveDiscretionary bonusesCompany OverviewNJM (New Jersey Manufacturers) is an auto, homeowners, renters, commercial auto, umbrella and workers' compensation insurance providers. It was founded in 1913, and is headquartered in West Trenton, New Jersey, USA, with a workforce of 1001-5000 employees. Its website is https://www.njm.com.



Apply Now