• The Claim Account Specialist 2 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 Claim Account Specialist 2 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.
• Monday-Friday, specific hours are subject to selected start time between 8:00am-8:45am pending supervisory approval.
• $54,000 – $68,000. Salary is commensurate with experience and credentials.

NJM’s Workers’ Compensation Claims Team is seeking a Claim Account Specialist, Level II. This is a full-time position and offers a hybrid schedule after training, working from home 3 days per week.

This role can be based in any of our three New Jersey office locations: West Trenton, Hammonton or Parsippany.

Schedule: Monday-Friday, specific hours are subject to selected start time between 8:00am-8:45am pending supervisory approval.

Salary Range: $54,000 – $68,000. Salary is commensurate with experience and credentials.

Job Description

The Claim Account Specialist 2 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 Claim Account Specialist 2 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.

• Investigate and analyze the loss event, injury, and relevant information to make a compensability determination and recommend a course of action. Recognize and investigate subrogation opportunity for recovery of third-party funds. Investigate potential fraud indicators in collaboration with the SIU team.
• Prepare, attend, and participate in Claim Reviews as needed with the Claims Supervisor. Administer the delivery of timely, appropriate, and accurate indemnity and medical benefits. Work with the policyholder and NJM Loss Control to assist and develop stay at work / return to work efforts.
• 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.
• Participate in training programs to keep current on relevant issues/topics.
• 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. 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.
• Provide a high level of customer service and excellent communication with all stakeholders (injured workers, providers, attorneys, brokers, clients, etc.). Recommend process improvements where applicable to improve department efficiency, work product, and service commitment to interested parties.

• 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 and excellent communication with all stakeholders (injured workers, providers, attorneys, brokers, clients, etc.)
• 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
• 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
• Prepare, attend, and participate in Claim Reviews as needed with the Claims Supervisor
• 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
• 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

• Intermediate knowledge of WC Law of applicable jurisdiction and experience in deciding compensability issues, inclusive of medical causal relationship. Strong knowledge of medical terminology and medical procedures. Strong knowledge utilizing an automated claim processing system and the Microsoft Office suite of tools (Word, Excel).
• 3-5 years’ work experience as a Workers' Comp Claim Representative, or comparable knowledge and experience with various aspects of claims handling and/or process. Multi-state experience and/or licensing (including NJ, MD, CT, DE, PA and/or NY).
• Superior customer service skills and ability to engage in business interactions with a polite, courteous, and professional manner. 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.
• Demonstrated decision-making and critical thinking capabilities.
• Associate’s or Bachelor’s degree.
• Ability to travel for business purposes, approximately less than 10%.

• 3-5 years’ work experience as a Workers' Comp Claim Representative, or comparable knowledge and experience with various aspects of claims handling and/or process
• Intermediate knowledge of WC Law of applicable jurisdiction and experience in deciding compensability issues, inclusive of medical causal relationship
• Ability to manage return to work expectations with employers, doctors, and injured workers
• Strong knowledge of medical terminology and medical procedures
• Strong written and oral communication skills with ability to work both in a team setting and independently.
• Demonstrated decision-making and critical thinking capabilities
• Superior customer service skills and ability to engage in business interactions with a polite, courteous, and professional manner
• Strong knowledge utilizing an automated claim processing system and the Microsoft Office suite of tools (Word, Excel)
• Ability to travel for business purposes, approximately less than 10%

• Multi-state experience and/or licensing (including NJ, MD, CT, DE, PA and/or NY)
• Associate’s or Bachelor’s degree
• AIC/CPCU Designations