Workers' Compensation Claims Analyst - 3+ Years of Exp. Required

Job Description Summary:

The Workers' Compensation Claims Analyst is responsible for the independent, prompt, and efficient evaluation, investigation, and resolution of assigned clients’ claims in accordance with legal statutes, policy provisions, and company guidelines to achieve positive results. Through effective investigation, coordination of medical care, negotiation, and interaction with clients, claimants, medical professionals, attorneys, and insurers ensure that the most advantageous outcomes are achieved, and client resources are utilized in a cost-effective manner. This position also provides technical expertise and serves as an advocate on client claim issues.

Duties/Responsibilities:

Duties include but are not limited to:

• Promptly investigate all assigned claims from basic to more complex medical and indemnity files with minimal supervision
• Make timely compensability determinations in accordance with jurisdictional requirements.
• Document action plan for claim resolution including medical, disability, litigation, negotiation, and final disposition.
• Establish appropriate reserves with documented rationale and update at diary intervals to reflect changes in exposure.
• Identify potential fraud indicators and notify management for further investigation.
• Identify and document insurance coverage and client self-insured retention.
• Notify excess carriers according to carrier guidelines, provide quarterly updates, and request timely reimbursement.
• Identify and pursue subrogation recovery potential and second injury fund where applicable.
• Manage medical treatment including network occupational provider utilization, pre-authorization of surgical intervention, complete surgical data worksheet, and approve bills.
• Calculate and timely pay indemnity benefits.
• Coordinate with medical professionals and clients to achieve an early return to work and transitional modified duty where appropriate.
• Negotiate claims settlements within granted authority and accurately process and track award payments.
• Execute activities according to NJ statute, best practices, and client handling instructions.
• Highly effective verbal and written communication with internal and external parties to support the prompt resolution of claims and return to work in the most cost-effective manner.
• Maintain current knowledge of New Jersey jurisdictional requirements and applicable case law.

Requirements and Qualifications:

• Associate degree and/or three Years of equivalent work experience in an insurance-related industry required; bachelor’s degree preferred.
• 3+ Years ofWorkers' Compensation Claims experience required.
• Public Entity experience a plus

·         Must be detail-oriented and have strong customer service skills.

·         Must be proficient in the use of the Internet and Microsoft Office and capable of learning industry-specific software.

·         Demonstrated strong written and oral communication skills.

·         Demonstrated strong interpersonal, analytical, investigative, and negotiation skills.

·         As required, maintains insurance adjuster licenses

Physical Requirements:

·         Prolonged periods of sitting at a desk and working on a computer.

Growth and development:

• Whether you are new or have extensive experience, we promote a lifelong learning approach. Claim Resolution Corporation, Inc.’s goal is to provide you with the tools and training to be highly successful as a respected insurance professional.

Employee Benefits:

• The well-being of our employees is important to us. We offer a comprehensive benefits package including paid time off, medical, dental, vision, 401k, LTD, STD, and Group Life Insurance.

·         If you meet the above requirements and want to join a high-performing team, please forward your resume for consideration.

Claims Resolution Corporation, Inc. is an Equal Opportunity Employer, providing employment opportunities to all qualified individuals regardless of race, creed, color, sex, sexual orientation, religion, national origin, age, disability, or any other basis prohibited by law.

This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.