There’s never been a better time to join NJM!  With a nationally ranked reputation for outstanding customer service and  a history that spans more than a century, NJM is a leading provider of worker’s compensation, automobile and homeowners insurance in New Jersey .   It is an exciting time to join NJM as we are expanding into other states.     
                               
Become a member of our team and you’ll be part of company who operates for the sole benefit of its policyholders and is committed to maintaining the highest levels of service.  Team members are offered a competitive compensation package and benefits including: a 401k plan, health coverage, a generous paid time off plan, and much more!  What is it like to work at NJM?  Click here to see!                                                                                                                                                                   
Reporting to the Workers' Compensation Claims Territory Supervisor, the Workers’ Compensation Claim Representative will be based in our Parsippany, NJ location and is responsible for preparing a complete and thorough investigation on assigned claims that ultimately leads to a compensability decision and a course of action to manage the claim.  The incumbent will be responsible for contacting all parties involved in the claim, gathering and securing all necessary information to effectively evaluate the claim and outlining and recommending an action plan to manage the claim.  The Claim Representative is accountable for the claim results of all assigned claims.                                                                                                                 

The position 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 needed.   The Claim Representative will prepare, attend, and conduct Claim Reviews in partnership with the Territory Supervisor.

To accomplish this, the Workers’ Compensation Claim Representative:
•    Investigates and analyzes the loss event, the injury, and the relevant information to make a compensability determination and recommend a course of action.
•    Initiates and provides excellent communication with all stakeholders during the course of the claim.
•    Manages the claim, which includes the issuance of indemnity payments, monitoring the medical treatment, evaluating  the appropriateness of making a voluntary offer of partial permanent disability,  and all other events relevant to the claim
•    Evaluates the claim for potential fraud and escalates the file to SIU, as appropriate.
•    Coordinates with other NJM resources, including but not limited to:  WC Medical Services Administration, WC Sales, WC Underwriting, WC SIU, and Legal to bring special skills to the claim as needed.
•    Works with the policyholder and NJM Loss Control to assist and develop an Early Return to Work (ERTW) Program, and evaluate the ERTW opportunities to recommend a course of action to the policyholder/injured worker.
•    Builds rapport with the policyholder, conduct on-site investigations, educate the policyholder on NJM procedures, policies, and claim practices to which they should adhere, and evaluate the policyholder’s reporting practices.
•    Prepares, attends and conducts Claim Reviews, in partnership with the Territory Supervisor.
•    Documents all actions taken throughout the course of the claim.
•    Complies with, and conducts all activities within, state WC claims laws and fair practices, NJM’s Code of Ethics, and NJM’s Best Practices and Policies.

Required Qualifications and Experience:
•    3-5 years’ work experience as a Workers' Comp Claim Representative, or comparable insurance knowledge and experience with various aspects of Workers' Comp claims handling and/or process preferred.
•    Experience utilizing an automated claim processing system preferred.
•    Excellent communication skills.
•    Professional telephone skills/etiquette.
•    Strong interpersonal skills.
•    Ability to work in a team and independently.
•    Good organizational skills, able to multi-task, detail oriented, and data entry skills.
•    Good decision making capabilities.
•    Experience with the Office 2000 Professional suite of tools (Word, Excel).
•    High School Diploma or GED equivalent is required
•    Some travel is required
•    If not already licensed will be required to obtain Multi-State Licenses after hire                                                                                
 

Preferred:
•    Workers Compensation Claims knowledge with an emphasis on NJ 
o    Knowledge in additional covered states is a plus. Additional covered States include MD, CT, DE, PA and/or NY. 
•    Bachelor’s Degree is preferred
•    Medical Terminology knowledge is preferred
•    AIC Designation
•    Negotiation Skills
•    Workers Compensation Court Experience
•    Knowledge of OnBase, Claims Center, Guidewire and/or Xpressions 
•    Bi-Lingual Skills are a plus

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.