Claims Representative (Medical Only)

1.

Summary :

Under the supervision of a Claims Supervisor, a Claims Representative investigates, evaluates and manages assigned medical only workers' compensation claims in accordance with Claims Department procedures. 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; 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; and, j. Approves benefit payments as well as payment of medical and legal expenses. 3.

Qualifications :

a. Bachelor's Degree, or four years' experience in the insurance industry in a Claims Department; b. Minimum of one year experience in adjusting workers' compensation claims in the State of New Jersey required, experience adjusting workers' compensation for an intergovernmental risk pool is preferred; c. 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, d. 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 = $51,606.00 - $67,411.00 (Min-Mid)

Job Type:

Full-time Pay:

$51,606.00 - $67,411.00 per year

Benefits:

Dental insurance Health insurance Paid time off Vision insurance

Work Location:

Hybrid remote in Mount Laurel, NJ 08054