NJM’s Workers’ Compensation Claims Team is seeking three Claim Account Specialists. This is a full-time position and offers a hybrid schedule after training.

　　The Claims Account Specialist 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 Claims Account Specialist 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, other departments within NJM, and vendors as needed.

　　This role will be based in NJM’s Parsippany, NJ office location.

　　Responsibilities:

　　Execute on strategic and operational goals and objectives of the WCC department and company business goals, guidelines, and programs

　　Recommend process improvements where applicable to improve department efficiency, work product, and service commitment to interested parties

　　Ensure 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 activity

　　Investigate and analyze the loss event, injury, and relevant information to make a compensability determination and recommend a course of action

　　Administer the delivery of timely, appropriate, and accurate indemnity and medical benefits

　　Provide a high level of customer service that promotes injured worker advocacy-based principles to maximize return to work motivation and improve outcomes for all parties

　　Recognize and investigate subrogation opportunity for recovery of third-party funds

　　Work with the policyholder and NJM Loss Control to assist and develop stay at work / return to work efforts

　　Investigate potential fraud indicators in collaboration with the SIU team

　　Initiate and provide excellent communication with all stakeholders (injured workers, providers, attorneys, brokers, clients, etc.) professionally and proactively with a customer-centric approach

　　Consistently question and probe all aspects of assigned claims to achieve full understanding of facts

　　Comply with, and conduct all activities within state WC claims laws and fair practices, NJM’s Code of Ethics, and NJM’s Best Practices and Policies

　　Build rapport with the policyholder, educate the policyholder on NJM procedures, policies, and claim practices, and evaluate the policyholder’s reporting practices

　　Include accountability in managing service expectations and rapport and trust with assigned large accounts

　　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

　　Required Qualifications and Experience:

　　Level 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 system.

　　Level 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 system.

　　Sr 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 system.

　　Ability to manage return to work expectations with employers, doctors, and injured workers

　　Strong written and oral communication skills with ability to work both in a team setting and independently

　　Sound decision-making and critical thinking capabilities

　　Demonstrated organizational and communication skills

　　Superior customer service skills and ability to engage in business interactions with a polite, courteous, and professional manner

　　Working knowledge of Microsoft Office suite of tools (Word, Excel)

　　Ability to travel for business purposes, approximately less than 10%

　　Preferred:

　　Multi-state experience and/or licensing (including NJ, MD, CT, DE, PA and/or NY)

　　Associate’s or Bachelor’s degree

　　AIC/CPCU Designations

　　Salary:

　　Level I - $48K - $56K annually based on experience and credentials

　　Level II - $55K+ annually based on experience and credentials

　　Sr Level - $73K+ annually based on 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.

　　This isn’t just insurance. It’s NJM. When you join the NJM family, you’ll work with talented people who care about doing the right thing by our policyholders as well as each other. You’ll be part of a financially strong and stable company that has flourished on relationships, integrity, and service for more than a century. NJM is a special place where you can propel your career, help others, and make friends – all at the same time.

　　NJM is proud to offer our employees continuous learning options, outstanding benefits, access to wellness programs, and a wide range of opportunities to give back to the communities we are privileged to serve.

　　We have been named a Forbes America's Best-in-State Employer for four consecutive years.

　　Come join us! It’s time for you to make a difference alongside our remarkable team.