Home
/
Comprehensive
/
Regional Claims Specialist II
Regional Claims Specialist II-July 2024
Trenton
Jul 8, 2025
About Regional Claims Specialist II

  Job Description

  The Regional Claim 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 outlining and recommending an action plan to manage the claim. The Regional Claim Specialist 2 will work with and communicate to all internal and external stakeholders, including: 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. This is an intermediate level position in the Regional Claim track that will require basic supervision, guidance and coaching in the skill development of the role.

  Responsibilities:

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

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

  Effectively manage litigated claims through proactive execution of action plans to resolve claim issues to move cases toward closure and reduce aged inventory

  Will develop plans of action for the exploration of early RTW programs, MMI status, and with Supervisor guidance, legal and settlement of cases to resolve timely and for best outcomes

  Ensure quality management of claims in accordance with claims best practices and company guidelines, and timely, accurate documentation of claim activity

  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

  Investigate and determine compensability and coverage issues by gathering medical and factual evidence

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

  Evaluate the claim for potential fraud indicators and escalates the file to SIU, as appropriate

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

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

  Apply critical thinking skills to evaluate and mitigate exposures, and establish and implement a proactive strategic plan of action

  Identify claims for legal referral and collaborate on settlement strategies with Defense Counsel

  Promptly manage and resolve issues on litigated cases, inclusive of evaluating claim exposure, negotiating, and resolving claims

  Build rapport with the policyholder, conduct on-site investigations when necessary, and educate the policyholder on NJM legal procedures, policies, and claim practices

  Prepare, attend, and lead Claim Reviews as needed with the Claims Supervisor

  Assist in the preparation and utilization of Medicare Set-asides and annuities to bring cases to a full and final closure

  Participate in in-house and outside 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:

  3-5 years’ experience as a Regional Workers’ Comp Claim Representative, or comparable insurance knowledge and experience with various aspects of claims handling and processes

  Intermediate knowledge of WC regulations and jurisdiction(s) to be able to formulate an action plan to bring claims to resolution

  Intermediate through demonstrated knowledge of understanding 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

  Proficient knowledge utilizing an automated claim processing system and the Microsoft Office suite of tools (Word, Excel)

  Adjuster License as required

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

  High School Diploma or GED

  Preferred:

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

  Associate’s or Bachelor’s degree

  Possible completion of classes towards insurance industry designations including but not limited to AIC and/or CPCU

  Level of Authority:

  Work with defense counsel to resolve the claim within given authority

  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.

Comments
Welcome to zdrecruit comments! Please keep conversations courteous and on-topic. To fosterproductive and respectful conversations, you may see comments from our Community Managers.
Sign up to post
Sort by
Show More Comments
SIMILAR JOBS
Travel Medical Surgical RN/Brandon/2376444
This Position is for a Travel Medical Surgical RN with a company located in Brandon.   Job Summary: Travel Medical Surgical RN job in Brandon, MS.  3x12-Hour 19:00-07:00. 13 weeks.   Duties And Respo
Electrical Engineer
Company Description Work with Us. Change the World. At AECOM, we're delivering a better world. Whether improving your commute, keeping the lights on, providing access to clean water, or transforming
Ultrasound Technologist
Description Introduction Are you looking for a work environment where diversity and inclusion thrive? Submit your application for our Ultrasound Technologist opening with Chester Women's Health today
Account Receivable Specialist
PURPOSE: This position is responsible for compiling and maintaining accounts receivable records and functions as lead A/R member requiring systems and procedures training to less tenured members of t
BILINGUAL SUBSTANCE ABUSE COUNSELOR
Reference #: 7626Job DescriptionBenefits Information Full-time employees will enjoy a competitive benefits package with options for you and your family including:* Paid Time Off* Paid Holidays 401(k)
Shift Manager
We want you to join us, because Dunkin’ runs on you and we’ll be running beside you every step of the way. Keeping America running is a big deal, and we’re proud to be Movin’ and Shakin’ to fuel the
Child Life Specialist Children of Adult Patients/ Ambulatory Clinics
Overview $4,000 sign-on/retention bonus The Child Life Program at Dartmouth-Hitchcock is a regional service providing programming throughout central and southern New Hampshire. Our goal is to help ch
Accounts Assistant - Receivables
Description: You will be responsible to provide an excellent and consistent level of administrative support to your customers. Supports the smooth and efficient running of the Accounting Department Q
Advanced Client Trainer
Advanced Client Trainer Wolters Kluwer USA-IL-Remote With nearly two centuries of experience, Wolters Kluwer provides information and professional services for accounting, audit, business, compliance
Cashier
Overview: Privacy Notice: Visit https://www.raisingcanes.com/candidate-privacy-notice/ to review our Candidate Privacy Notice. Privacy Notice: Visit https://www.raisingcanes.com/candidate-privacy-not
Copyright 2023-2025 - www.zdrecruit.com All Rights Reserved