Claims Examiner (workers’ compensation)

1. Summary:

Under the supervision of a Claims Supervisor, a Claims Examiner investigates, evaluates and manages assigned indemnity workers’ compensation claims in accordance with Claims Department procedures. This includes developing a measure of loss for each assigned claim, resolving claims within the limits of authority where possible and obtaining management authority to resolve claims when necessary. A Claims Examiner operates with additional authority compared to a Senior Claims Representative, and with significantly more autonomy.

2. Functions:

a. Initiates contact with individuals involved in claims and acquires information concerning the loss;

b. Assembles and arranges factual information in a manner adequate to justify disposition subject to management authority;

c. Develops a measure of damage for each loss;

d. Consults with medical staff and legal counsel as necessary;

e. Evaluates exposure and determines the action necessary to dispose of loss within authority level where possible;

f. Initiates with Management authority the actions necessary to dispose of loss;

g. Assembles, maintains, and prepares records;

h. Reviews medical expense bills for appropriateness and payment;

i. Provides customer service to internal and external clients relating to their claims;

j. Responsible for identifying potential subrogation recovery opportunities and overseeing any recovery action;

k. Approves benefit payments as well as payment of medical and legal expenses; and,

l. Special projects as required.

3. Qualifications:

a. Bachelor’s degree in Business Administration, Finance or Accounting or equivalent work experience required;

b. Minimum of five years’ experience in adjusting workers’ compensation indemnity claims in the State of New Jersey required, experience adjusting workers’ compensation for an intergovernmental risk pool is preferred;

c. Experience adjusting workers’ compensation in the State of New Jersey to conclusion under Section 20 (N.J.S.A. 34:15-20);

d. Associate in Risk Management, Certified Risk Manager, or Associate in General Insurance designation preferred;

e. Ability to work in an office environment with moderate noise level, ability able to work flexible hours, including evenings and weekends, and the ability to travel to other offices and client, carrier, and work sites as required; and,

f. Residency in the State of New Jersey in accordance with the New Jersey First Act, N.J.S.A. 52:14-7, et seq., unless otherwise exempted.

Salary = $67,241 - $87,833 Min - Mid per year

Job Type: Full-time

Pay: $67,241.00 - $87,833.00 per year

Benefits:

• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Work Location: In person

Salary : $67,241 - $87,833