Sr. Workers Compensation Claims Specialist

United States·Hartfordsenior

Legal & ComplianceClaims Specialist

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Quick Summary

Key Responsibilities

Ensure quality management of claims in accordance with claims best practices and company guidelines, and timely,

Requirements Summary

5+ years’ experience as a Workers' Comp Claim Representative,

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Legal & ComplianceClaims Specialist

NJM’s WC Claims Department is seeking an experienced Sr. Workers Compensation Claims Specialist who lives in or near Connecticut to provide on-site service to our policyholders and agents in that state. This is a 100% remote position which includes virtual claims handling for customers in any area of CT and possibly MD, DE or PA as needed.

Responsibilities

~2 min read

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Ensure quality management of claims in accordance with claims best practices and company guidelines, and timely, accurate documentation of claim activity
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Provide a high level of customer service that promotes injured worker advocacy-based principles to improve outcomes for all parties
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Determine compensability and coverage issues by gathering medical and factual evidence
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Administer the delivery of timely, appropriate, and accurate benefits
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Evaluate the claim for potential fraud indicators and escalate the claim to SIU, as appropriate
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Recognize and investigate subrogation opportunity and refer to NJM subrogation staff for recovery of third-party funds
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Initiate and provide excellent communication with all stakeholders (injured workers, medical providers, attorneys, policyholders, agents, etc.) professionally and proactively with a customer-centric approach
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Apply critical thinking skills to evaluate and mitigate exposures, and establish and implement a proactive strategic plan of action
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Assign and refer claim petitions to Counsel, and work to resolve the claim within given authority
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Build rapport with policyholders and agents, conduct on-site investigations when necessary, and educate policyholders and agents on NJM procedures, policies, and claim practices
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Prepare and attend Claim Reviews at policyholder or agent locations in CT or virtually for further locations.
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Serve as a liaison between policyholders/agents and various departments in NJM.
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Represent WC Claim in on-site capabilities meetings to onboard new policyholders in CT.
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Participate in training programs to keep current on relevant issues/topics
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Recommend process improvement where applicable to best improve the department efficiency, work product, and service commitment to interested parties
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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

Requirements

~1 min read

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 medical terminology and WC regulations for CT claims.
Knowledge of and/or experience working with liens and Medicare Set-Asides to secure full and final settlements
Customer service oriented with strong written and oral communication skills
Strong interpersonal skills with ability to work both in a team and independently
Demonstrated organizational skills, and use of sound decision-making capabilities
Working knowledge utilizing an automated claim processing system and Microsoft Office tools including Word and Outlook
Licensed in CT to adjust WC claims.
Ability to travel for business purposes, approximately 2 – 3 days a week meeting with policyholders and/or agents

Nice to Have

~1 min read

Associate or bachelor’s degree
AIC/CPCU or other applicable insurance designations
Experience using Guidewire Claim Center, OnBase and additional Microsoft Office tools including Teams, Excel and PowerPoint
Knowledge and experience in WC claims handling in various states including PA, MD and/or DE.
Licensed in other states including DE to adjust WC claims.

Compensation: Salary is commensurate with experience and credentials.

Pay Range: $81,124-$94,141

Eligible full-time employees receive a competitive Total Rewards package, including but not limited to a 401(k) with employer match up to 8% and additional service-based contributions, Health, Dental, and Vision insurance, Life and Disability coverage, generous PTO, Paid Sick Leave, and paid parental leave in addition to state-mandated leave. Employees may also be eligible for discretionary bonuses.

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.