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  • Claims Representative, PIP

    Plymouth Rock Assurance 4.7company rating

    Claim Processor Job In Woodbridge, NJ

    In this fast-paced role, the PIP Representatives adjusts first party personal injury claims according to state compliance requirements and guidelines. Essential Functions and Responsibilities will handle lower severity Personal Injury Protection claims in multiple states. The PIP Claim Representative will receive between 3 to 5 first reports a day with a priority on patient contact, service, and claim disposition. Daily duties include first reports, Image Right tasks, medical bill review, treatment monitoring, reserve assessment and Nursing interaction. Maintains an effective follow-up system on pending files, prioritize and handle multiple tasks simultaneously, adjust to fluctuating workload, advises injured parties as to the status of the claim. Investigates and interprets policy provisions and conditions to make a coverage determination. Functional knowledge of medical terminology and anatomy with a thorough understanding of Personal Injury Protection claim handling regulatory requirements is preferred but not necessary. The PIP Claim Representative must have the ability to multitask in time sensitive situations. Ensures that service, loss and expense control are maintained at all times. Adheres to privacy guidelines, law and regulations pertaining to claims handling. Candidates must have strong customer service, organization, verbal and written skills and have the ability to work in a small team environment. Qualifications and Education Recent college graduates are encouraged to apply. A Bachelor's degree from an accredited four-year college or university is a plus. Basic personal computer skills including working knowledge of Microsoft Office Suite products. About the Company The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of “A-/Excellent”.
    $43k-54k yearly est. 12d ago
  • Multi-Line Claims Examiner

    W.R. Berkley Corporation 4.2company rating

    Claim Processor Job In Moorestown, NJ

    Company Details What makes Admiral Insurance Group ADMIRABLE. Since 1974, Admiral Insurance Group has been supporting business innovation and market growth through our wholesale-dedicated excess and surplus (E&S) lines of commercial insurance. We specialize in underwriting difficult-to-place moderate to high-risk commercial businesses that require creative solutions, outside of the box thinking, entrepreneurial spirit and astute business knowledge. As a member of the W. R. Berkley Corporation, a Fortune 500 Company and one of the nation's premier commercial lines property casualty insurance providers, we have the resources, support and industry data to provide exceptional service and exciting solutions for our clients and partners. Unlock your insure-ability. Learn more about Careers at Admiral Insurance Group. See what it's like to work in Admiral's Claims department. The Company is an equal employment opportunity employer. Responsibilities The Multi-Line Claims Examiner is responsible for determining and discharging the company's contractual obligations under its various policy contracts involving coverage analysis, investigation, legal defense, and loss and expense reserving. * Incorporate all claims into company records and review for applicability of coverage. * Conference coverage questions, reserves, and settlement authority with Manager and Claims Committee pursuant to best practices, including preparation of large loss reports. * Present facts of claims, with recommendations, to committee as necessary. * Establish initial loss and expense reserves. Maintain valid loss and expense reserves based on current investigation and legal discovery. * Provide ongoing direction to adjusters, investigators and defense attorneys to ensure that all claims are adequately handled. Attend and participate in mediations and trials as necessary with supervision. * Adhere to company procedures and guidelines as well as case law and statutory requirements when coverage is in question, and/or when paying or denying claims. * Review trade journals, Unfair Claim Practice Acts, etc. to ensure current understanding as they relate to the specified job duties. * Review incoming billing statements for accuracy and process for payment. * Attend industry related seminar workshops and/or courses for continuing education. * Additional tasks as assigned. Qualifications * Bachelor's Degree preferred (or equivalent work experience). * Minimum of three years of progressive commercial insurance claims handling experience. * Ability to assess priorities and manage deadlines effectively. * Effective communication skills, both verbal and written. * Strong research and analytical skills. * Must have strong problem-solving skills and excellent organization skills. * Must be customer service oriented. * Up to 20% travel. * Proficiency with MS Office Suite. Additional Company Details We do not accept any unsolicited resumes from external recruiting firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. Sponsorship Details Sponsorship not Offered for this Role Responsibilities The Multi-Line Claims Examiner is responsible for determining and discharging the company's contractual obligations under its various policy contracts involving coverage analysis, investigation, legal defense, and loss and expense reserving. - Incorporate all claims into company records and review for applicability of coverage. - Conference coverage questions, reserves, and settlement authority with Manager and Claims Committee pursuant to best practices, including preparation of large loss reports. - Present facts of claims, with recommendations, to committee as necessary. - Establish initial loss and expense reserves. Maintain valid loss and expense reserves based on current investigation and legal discovery. - Provide ongoing direction to adjusters, investigators and defense attorneys to ensure that all claims are adequately handled. Attend and participate in mediations and trials as necessary with supervision. - Adhere to company procedures and guidelines as well as case law and statutory requirements when coverage is in question, and/or when paying or denying claims. - Review trade journals, Unfair Claim Practice Acts, etc. to ensure current understanding as they relate to the specified job duties. - Review incoming billing statements for accuracy and process for payment. - Attend industry related seminar workshops and/or courses for continuing education. - Additional tasks as assigned.
    $103k-134k yearly est. 60d+ ago
  • Multi-Line Claims Examiner

    Berkley 4.3company rating

    Claim Processor Job In Moorestown, NJ

    Company Details What makes Admiral Insurance Group ADMIRABLE . Since 1974, Admiral Insurance Group has been supporting business innovation and market growth through our wholesale-dedicated excess and surplus (E&S) lines of commercial insurance. We specialize in underwriting difficult-to-place moderate to high-risk commercial businesses that require creative solutions, outside of the box thinking, entrepreneurial spirit and astute business knowledge. As a member of the W. R. Berkley Corporation, a Fortune 500 Company and one of the nation's premier commercial lines property casualty insurance providers, we have the resources, support and industry data to provide exceptional service and exciting solutions for our clients and partners. Unlock your insure -ability. Learn more about Careers at Admiral Insurance Group. See what it's like to work in Admiral's Claims department. The Company is an equal employment opportunity employer. Responsibilities The Multi-Line Claims Examiner is responsible for determining and discharging the company's contractual obligations under its various policy contracts involving coverage analysis, investigation, legal defense, and loss and expense reserving. Incorporate all claims into company records and review for applicability of coverage. Conference coverage questions, reserves, and settlement authority with Manager and Claims Committee pursuant to best practices, including preparation of large loss reports. Present facts of claims, with recommendations, to committee as necessary. Establish initial loss and expense reserves. Maintain valid loss and expense reserves based on current investigation and legal discovery. Provide ongoing direction to adjusters, investigators and defense attorneys to ensure that all claims are adequately handled. Attend and participate in mediations and trials as necessary with supervision. Adhere to company procedures and guidelines as well as case law and statutory requirements when coverage is in question, and/or when paying or denying claims. Review trade journals, Unfair Claim Practice Acts, etc. to ensure current understanding as they relate to the specified job duties. Review incoming billing statements for accuracy and process for payment. Attend industry related seminar workshops and/or courses for continuing education. Additional tasks as assigned. Qualifications Bachelor's Degree preferred (or equivalent work experience). Minimum of three years of progressive commercial insurance claims handling experience. Ability to assess priorities and manage deadlines effectively. Effective communication skills, both verbal and written. Strong research and analytical skills. Must have strong problem-solving skills and excellent organization skills. Must be customer service oriented. Up to 20% travel. Proficiency with MS Office Suite. Additional Company Details We do not accept any unsolicited resumes from external recruiting firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. Sponsorship Details Sponsorship not Offered for this Role
    $70k-101k yearly est. 60d+ ago
  • Claims Specialist I-Property

    Everest Group Ltd. 3.8company rating

    Claim Processor Job In Philadelphia, PA

    About Everest Everest Group, Ltd. (Everest), is a leading global reinsurance and insurance provider, operating for nearly 50 years through subsidiaries in North America, Latin America, the UK & Ireland, Continental Europe and Asia Pacific regions. Throughout our history, Everest has maintained its discipline and focuses on creating long-term value through underwriting excellence and strong risk and capital management. Our strengths include extensive product and distribution capabilities, a strong balance sheet, and an innovative culture. Our most critical asset is our people. We offer dynamic training & professional development to our employees. We also offer generous tuition/continuing education reimbursement programs, mentoring opportunities, flexible work arrangements, and Colleague Resource Groups. The Claims Team at Everest Insurance, a member of the Everest Re Group, is looking for an experienced Commercial Property Claims Specialist to join our Property and Inland Marine Claims team. The preferred location is Warren, NJ but would consider other locations based upon experience. Responsibilities include but not limited to: * Experience handling Commercial Property and/or Builders Risk Claims. * Strong knowledge of Property Forms and Endorsements. * Ability to manage Independent Adjusters. * Ability to review and analyze property damage estimates. * Review and analyze coverage and prepare appropriate coverage position letters. * Investigation, analysis, and evaluation of assigned claims to determine exposure. * Management and direction of outside counsel as well as reviewing and approving legal and/or expense budgets and bills. * Preparation of case summary reports related to matters of significant reserve activity. * Timely and appropriate setting of claim reserves. * Development and execution of claim strategies as well as resolution strategies. * Negotiation and resolution of claims. * Determine and resolve workload and assignment issues to ensure effective claims processing, expense management and claims disposition. * Attend trials and mediations. * Vendor oversight and management, including auditing of same. * Identify issues and trends in the portfolio; take appropriate and/or corrective action where necessary; communicate trends to underwriters, insureds, and brokers. * Extensive communication with insureds, brokers, reinsurers, actuaries, and business unit contacts. * Attend client meetings and industry functions to support retention and development of client relationships and business. Qualifications, Education & Experience: * The ideal candidate will have 5+ years of Commercial Property claims experience and current, working knowledge of jurisdictional laws and regulations. * Bachelor's degree or equivalent work experience required. * Insurance industry designation(s)/certification(s) preferred. Knowledge, Skills & Competencies: * Strong oral and written communication skills. * Strong analytical and organizational skills. * Strong negotiation and investigation skills. * Excellent interpersonal skills. * Ability to evaluate coverage issues involving a wide variety of loss scenarios. * Ability to think strategically. * Currently holds or readily can obtain all required adjuster licenses. * Knowledge of the insurance industry, claims and the insurance legal and regulatory environment. * Knowledge of claims handling or insurance legal statutes and procedures. * Ability to identify and use relevant data and metrics to best manage claims. * Collaborative mind-set and willingness to work with people outside immediate reporting hierarchy to improve processes and generate optimal departmental efficiency. * Ability to and willingness to present to senior management and other group settings. * Ability to influence others and resolve complex, disputed claims * Some travel required. Our Culture At Everest, our purpose is to provide the world with protection. We help clients and businesses thrive, fuel global economies, and create sustainable value for our colleagues, shareholders and the communities that we serve. We also pride ourselves on having a unique and inclusive culture which is driven by a unified set of values and behaviors. Click here to learn more about our culture. * Our Values are the guiding principles that inform our decisions, actions and behaviors. They are an expression of our culture and an integral part of how we work: Talent. Thoughtful assumption of risk. Execution. Efficiency. Humility. Leadership. Collaboration. Diversity, Equity and Inclusion. * Our Colleague Behaviors define how we operate and interact with each other no matter our location, level or function: Respect everyone. Pursue better. Lead by example. Own our outcomes. Win together. All colleagues are held accountable to upholding and supporting our values and behaviors across the company. This includes day to day interactions with fellow colleagues, and the global communities we serve. For NY Only: The base salary range for this position is $80,000 - $140,000 annually. The offered rate of compensation will be based on individual education, experience, qualifications and work location. #LI-Hybrid #LI-VP1 Type: Regular Time Type: Full time Primary Location: Warren, NJ Additional Locations: Atlanta, GA, Boston, MA, Hartford, CT, New York, NY, Philadelphia, PA Everest is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex (including pregnancy), sexual orientation, gender identity or expression, national origin or ancestry, citizenship, genetics, physical or mental disability, age, marital status, civil union status, family or parental status, veteran status, or any other characteristic protected by law. As part of this commitment, Everest will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Everest Benefits at *********************************. Everest U.S. Privacy Notice | Everest (everestglobal.com)
    $80k-140k yearly Easy Apply 13d ago
  • LTD Claims Examiner II

    Matrix Absence Management 3.5company rating

    Claim Processor Job In Philadelphia, PA

    Job Responsibilities and Requirements KEY RESPONSIBILITIES * other duties as assigned* Obtains and analyzes information to make claim decisions and payments on LTD, Voluntary disability and Waiver of Premium claims. The goal of the position/role is to consistently render appropriate claim determinations based on a review of all available information and the terms and provisions of the applicable policy. * Reviews and investigates disability claims by using telephone and written contact with the applicable parties, (claimant, employer/supervisor, credit union, treating physician, etc.) to gather pertinent data to analyze the claim. * Adjudicates claims accurately and fairly in accordance with the contract, appropriate claim policies and procedures, and state and federal regulations, meeting productivity and quality standards based on product line. * Utilizes appropriate medical and risk resources, adhering to referral polices, and transferring claims to the appropriate risk level in a timely manner. * Conducts in-depth pre-existing condition or contestable investigations if applicable. * Calculates benefit payments, which may include partial disability benefits, integration with other income sources, survivor benefits, residual disability benefits, etc. * Develops and maintains on-line claim data (and paper file if applicable). * Provide customer service that is respectful, prompt, concise, and accurate in an environment with competing demands. Analysis and Adjudication * Fully investigates and adjudicates a large volume simple to complex claims. * Identifies and investigates change in Total Disability definition (any occ). * Independently reviews and manage claims with high degree of complexity within the $1,500 per month approval authority limit. * Independently makes the determination if a policyholder with life policy up to $125,000 is eligible for a waiver of premium. * Majority of work is not subject to supervisor review and approval. Case Management * Consistently manage assigned case load of 60-80 simple to complex cases independently. * Collaborates with team members and management in identifying and implementing improvement opportunities. REQUIRED KNOWLEDGE, SKILLS, ABILITIES, COMPETENCIES, AND/OR RELATED EXPERIENCE * or equivalent experience gained from any combination of formal education, on-the-job training, and/or work and life experience* Required Knowledge, Skills, Abilities and/or Related Experience * High School Diploma or GED. Associates degree in Business, Finance, Social Work, or Human Resources preferred. Level I LOMA designation preferred. * 2 years experience processing long term disability claims. * Demonstrated understanding of claim management techniques and critical thinking in activities requiring analysis and/or investigation. * Experience working in confidential/protected identification environments. * Knowledge of medical terminology. * Good math and calculation skills. * Proven ability to work well in a high-visibility, public-oriented environment. Ability to Travel: None PHYSICAL REQUIREMENTS When used in the description below, the following terms are defined as: "Occasional": done only from time to time, but necessary when it is performed "Frequent": regularly performed; generally an act that is required on a daily basis "Continuous": typically performed for the majority of an employee's shift Sitting for prolonged periods of time, frequently standing, walking distances up to one mile, bending, crouching, kneeling, reaching, occasionally lifting 25lbs, extensive typing, picking up and holding small objecting and otherwise using primarily the fingers rather than the entire hand. Employee is required to have visual acuity sufficient to perform activities such as preparing and analyzing data and figures; transcribing notes; viewing a computer terminal and extensive reading. Employee is required to have hearing sufficient to understand verbal instruction and answer telephones. Reliance Matrix will provide qualified employees with a reasonable accommodation in accordance with applicable law. CORE VALUES * Collaboration * Compassion * Empowerment * Integrity * Fun The above description reflects the general details considered necessary to describe the principle responsibilities and functions of the job identified and shall not be construed as a detailed description of all the work requirements that may be inherent to this job. The expected hiring range for this position is $54,990.00 - $68,750.00 annually for work performed in the primary location (Philadelphia, PA). This expected hiring range covers only base pay and excludes any other compensation components such as commissions or incentive awards. The successful candidate's starting base pay will be based on several factors including work location, job-related skills, experience, qualifications, and market conditions. These ranges may be modified in the future. Work location may be flexible if approved by the Company. What We Offer At Reliance Matrix, we believe that creating a more diverse, equitable and inclusive culture allows us to realize more of our potential. And we can't do this without our most important asset-you. That is why we offer a competitive pay package and a range of benefits to help team members thrive in their financial, physical, and mental wellbeing. Our Benefits: * An annual performance bonus for all team members * Generous 401(k) company match that is immediately vested * A choice of three medical plans (that include prescription drug coverage) to suit your unique needs. For High Deductible Health Plan enrollees, a company contribution to your Health Savings Account * Multiple options for dental and vision coverage * Company provided Life & Disability Insurance to ensure financial protection when you need it most * Family friendly benefits including Paid Parental Leave & Adoption Assistance * Hybrid work arrangements for eligible roles * Tuition Reimbursement and Continuing Professional Education * Paid Time Off, volunteer days, community partnerships, and Employee Assistance Program * Ability to connect with colleagues around the country through our Employee Resource Group program and our Diversity Equity & Inclusion Council Our Values: * Integrity * Empowerment * Compassion * Collaboration * Fun EEO Statement Reliance Matrix is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, national origin, citizenship, age or disability, or any other classification or characteristic protected by federal or state law or regulation. We assure you that your opportunity for employment depends solely on your qualifications. #LI-Remote #LI-MR1
    $55k-68.8k yearly 14d ago
  • LTD Claims Examiner II

    Reliance Standard

    Claim Processor Job In Philadelphia, PA

    Job Responsibilities and Requirements KEY RESPONSIBILITIES * other duties as assigned* Obtains and analyzes information to make claim decisions and payments on LTD, Voluntary disability and Waiver of Premium claims. The goal of the position/role is to consistently render appropriate claim determinations based on a review of all available information and the terms and provisions of the applicable policy. * Reviews and investigates disability claims by using telephone and written contact with the applicable parties, (claimant, employer/supervisor, credit union, treating physician, etc.) to gather pertinent data to analyze the claim. * Adjudicates claims accurately and fairly in accordance with the contract, appropriate claim policies and procedures, and state and federal regulations, meeting productivity and quality standards based on product line. * Utilizes appropriate medical and risk resources, adhering to referral polices, and transferring claims to the appropriate risk level in a timely manner. * Conducts in-depth pre-existing condition or contestable investigations if applicable. * Calculates benefit payments, which may include partial disability benefits, integration with other income sources, survivor benefits, residual disability benefits, etc. * Develops and maintains on-line claim data (and paper file if applicable). * Provide customer service that is respectful, prompt, concise, and accurate in an environment with competing demands. Analysis and Adjudication * Fully investigates and adjudicates a large volume simple to complex claims. * Identifies and investigates change in Total Disability definition (any occ). * Independently reviews and manage claims with high degree of complexity within the $1,500 per month approval authority limit. * Independently makes the determination if a policyholder with life policy up to $125,000 is eligible for a waiver of premium. * Majority of work is not subject to supervisor review and approval. Case Management * Consistently manage assigned case load of 60-80 simple to complex cases independently. * Collaborates with team members and management in identifying and implementing improvement opportunities. REQUIRED KNOWLEDGE, SKILLS, ABILITIES, COMPETENCIES, AND/OR RELATED EXPERIENCE * or equivalent experience gained from any combination of formal education, on-the-job training, and/or work and life experience* Required Knowledge, Skills, Abilities and/or Related Experience * High School Diploma or GED. Associates degree in Business, Finance, Social Work, or Human Resources preferred. Level I LOMA designation preferred. * 2 years experience processing long term disability claims. * Demonstrated understanding of claim management techniques and critical thinking in activities requiring analysis and/or investigation. * Experience working in confidential/protected identification environments. * Knowledge of medical terminology. * Good math and calculation skills. * Proven ability to work well in a high-visibility, public-oriented environment. Ability to Travel: None PHYSICAL REQUIREMENTS When used in the description below, the following terms are defined as: "Occasional": done only from time to time, but necessary when it is performed "Frequent": regularly performed; generally an act that is required on a daily basis "Continuous": typically performed for the majority of an employee's shift Sitting for prolonged periods of time, frequently standing, walking distances up to one mile, bending, crouching, kneeling, reaching, occasionally lifting 25lbs, extensive typing, picking up and holding small objecting and otherwise using primarily the fingers rather than the entire hand. Employee is required to have visual acuity sufficient to perform activities such as preparing and analyzing data and figures; transcribing notes; viewing a computer terminal and extensive reading. Employee is required to have hearing sufficient to understand verbal instruction and answer telephones. Reliance Matrix will provide qualified employees with a reasonable accommodation in accordance with applicable law. CORE VALUES * Collaboration * Compassion * Empowerment * Integrity * Fun The above description reflects the general details considered necessary to describe the principle responsibilities and functions of the job identified and shall not be construed as a detailed description of all the work requirements that may be inherent to this job. The expected hiring range for this position is $54,990.00 - $68,750.00 annually for work performed in the primary location (Philadelphia, PA). This expected hiring range covers only base pay and excludes any other compensation components such as commissions or incentive awards. The successful candidate's starting base pay will be based on several factors including work location, job-related skills, experience, qualifications, and market conditions. These ranges may be modified in the future. Work location may be flexible if approved by the Company. What We Offer At Reliance Matrix, we believe that creating a more diverse, equitable and inclusive culture allows us to realize more of our potential. And we can't do this without our most important asset-you. That is why we offer a competitive pay package and a range of benefits to help team members thrive in their financial, physical, and mental wellbeing. Our Benefits: * An annual performance bonus for all team members * Generous 401(k) company match that is immediately vested * A choice of three medical plans (that include prescription drug coverage) to suit your unique needs. For High Deductible Health Plan enrollees, a company contribution to your Health Savings Account * Multiple options for dental and vision coverage * Company provided Life & Disability Insurance to ensure financial protection when you need it most * Family friendly benefits including Paid Parental Leave & Adoption Assistance * Hybrid work arrangements for eligible roles * Tuition Reimbursement and Continuing Professional Education * Paid Time Off, volunteer days, community partnerships, and Employee Assistance Program * Ability to connect with colleagues around the country through our Employee Resource Group program and our Diversity Equity & Inclusion Council Our Values: * Integrity * Empowerment * Compassion * Collaboration * Fun EEO Statement Reliance Matrix is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, national origin, citizenship, age or disability, or any other classification or characteristic protected by federal or state law or regulation. We assure you that your opportunity for employment depends solely on your qualifications. #LI-Remote #LI-MR1
    $55k-68.8k yearly 14d ago
  • LTD Claims Examiner II

    Reliance Standard Life Insurance Company

    Claim Processor Job In Philadelphia, PA

    Job Responsibilities and Requirements KEY RESPONSIBILITIES *other duties as assigned* Obtains and analyzes information to make claim decisions and payments on LTD, Voluntary disability and Waiver of Premium claims. The goal of the position/role is to consistently render appropriate claim determinations based on a review of all available information and the terms and provisions of the applicable policy. Reviews and investigates disability claims by using telephone and written contact with the applicable parties, (claimant, employer/supervisor, credit union, treating physician, etc.) to gather pertinent data to analyze the claim. Adjudicates claims accurately and fairly in accordance with the contract, appropriate claim policies and procedures, and state and federal regulations, meeting productivity and quality standards based on product line. Utilizes appropriate medical and risk resources, adhering to referral polices, and transferring claims to the appropriate risk level in a timely manner. Conducts in-depth pre-existing condition or contestable investigations if applicable. Calculates benefit payments, which may include partial disability benefits, integration with other income sources, survivor benefits, residual disability benefits, etc. Develops and maintains on-line claim data (and paper file if applicable). Provide customer service that is respectful, prompt, concise, and accurate in an environment with competing demands. Analysis and Adjudication Fully investigates and adjudicates a large volume simple to complex claims. Identifies and investigates change in Total Disability definition (any occ). Independently reviews and manage claims with high degree of complexity within the $1,500 per month approval authority limit. Independently makes the determination if a policyholder with life policy up to $125,000 is eligible for a waiver of premium. Majority of work is not subject to supervisor review and approval. Case Management Consistently manage assigned case load of 60-80 simple to complex cases independently. Collaborates with team members and management in identifying and implementing improvement opportunities. REQUIRED KNOWLEDGE, SKILLS, ABILITIES, COMPETENCIES, AND/OR RELATED EXPERIENCE *or equivalent experience gained from any combination of formal education, on-the-job training, and/or work and life experience* Required Knowledge, Skills, Abilities and/or Related Experience High School Diploma or GED. Associates degree in Business, Finance, Social Work, or Human Resources preferred. Level I LOMA designation preferred. 2 years experience processing long term disability claims. Demonstrated understanding of claim management techniques and critical thinking in activities requiring analysis and/or investigation. Experience working in confidential/protected identification environments. Knowledge of medical terminology. Good math and calculation skills. Proven ability to work well in a high-visibility, public-oriented environment. Ability to Travel: None PHYSICAL REQUIREMENTS When used in the description below, the following terms are defined as: “Occasional”: done only from time to time, but necessary when it is performed “Frequent”: regularly performed; generally an act that is required on a daily basis “Continuous”: typically performed for the majority of an employee's shift Sitting for prolonged periods of time, frequently standing, walking distances up to one mile, bending, crouching, kneeling, reaching, occasionally lifting 25lbs, extensive typing, picking up and holding small objecting and otherwise using primarily the fingers rather than the entire hand. Employee is required to have visual acuity sufficient to perform activities such as preparing and analyzing data and figures; transcribing notes; viewing a computer terminal and extensive reading. Employee is required to have hearing sufficient to understand verbal instruction and answer telephones. Reliance Matrix will provide qualified employees with a reasonable accommodation in accordance with applicable law. CORE VALUES Collaboration Compassion Empowerment Integrity Fun The above description reflects the general details considered necessary to describe the principle responsibilities and functions of the job identified and shall not be construed as a detailed description of all the work requirements that may be inherent to this job. The expected hiring range for this position is $54,990.00 - $68,750.00 annually for work performed in the primary location (Philadelphia, PA). This expected hiring range covers only base pay and excludes any other compensation components such as commissions or incentive awards. The successful candidate's starting base pay will be based on several factors including work location, job-related skills, experience, qualifications, and market conditions. These ranges may be modified in the future. Work location may be flexible if approved by the Company. What We Offer At Reliance Matrix, we believe that creating a more diverse, equitable and inclusive culture allows us to realize more of our potential. And we can't do this without our most important asset-you. That is why we offer a competitive pay package and a range of benefits to help team members thrive in their financial, physical, and mental wellbeing. Our Benefits: An annual performance bonus for all team members Generous 401(k) company match that is immediately vested A choice of three medical plans (that include prescription drug coverage) to suit your unique needs. For High Deductible Health Plan enrollees, a company contribution to your Health Savings Account Multiple options for dental and vision coverage Company provided Life & Disability Insurance to ensure financial protection when you need it most Family friendly benefits including Paid Parental Leave & Adoption Assistance Hybrid work arrangements for eligible roles Tuition Reimbursement and Continuing Professional Education Paid Time Off, volunteer days, community partnerships, and Employee Assistance Program Ability to connect with colleagues around the country through our Employee Resource Group program and our Diversity Equity & Inclusion Council Our Values: Integrity Empowerment Compassion Collaboration Fun EEO Statement Reliance Matrix is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, national origin, citizenship, age or disability, or any other classification or characteristic protected by federal or state law or regulation. We assure you that your opportunity for employment depends solely on your qualifications. #LI-Remote #LI-MR1
    $55k-68.8k yearly 11d ago
  • Claims Examiner, Bodily Injury

    Sedgwick 4.4company rating

    Claim Processor Job In Trenton, NJ

    Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive. A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work. Great Place to Work Most Loved Workplace Forbes Best-in-State Employer Claims Examiner, Bodily Injury **PRIMARY PURPOSE** : To analyze and process complex auto and commercial transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly. + Responsible for litigation process on litigated claims. + Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims. + Reports large claims to excess carrier(s). + Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution. + Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage. + Communicates claim action/processing with insured, client, and agent or broker when appropriate. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required. **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position. **Experience** Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws. **Skills & Knowledge** + In-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws + Knowledge of medical terminology for claim evaluation and Medicare compliance + Knowledge of appropriate application for deductibles, sub-limits, SIR's, carrier and large deductible programs. + Strong oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Strong organizational skills + Strong interpersonal skills + Good negotiation skills + Ability to work in a team environment + Ability to meet or exceed Service Expectations **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical:** Computer keyboarding, travel as required **Auditory/Visual:** Hearing, vision and talking _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is_ **_$65,000- $77,000_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ **_Always accepting applications._** The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Taking care of people is at the heart of everything we do. Caring counts** Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (************************************** BGSfA)
    $65k-77k yearly 53d ago
  • Claims Specialist (DP&E)

    Axis Capital Holdings Ltd. 4.0company rating

    Claim Processor Job In Princeton, NJ

    This is your opportunity to join AXIS Capital - a trusted global provider of specialty lines insurance and reinsurance. We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns for our shareholders. We also proudly maintain an entrepreneurial, disciplined and ethical corporate culture. As a member of AXIS, you join a team that is among the best in the industry. At AXIS, we believe that we are only as strong as our people. We strive to create an inclusive and welcoming culture where employees of all backgrounds and from all walks of life feel comfortable and empowered to be themselves. This means that we bring our whole selves to work. All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin or ancestry, citizenship, physical or mental disability, age, marital status, civil union status, family or parental status, or any other characteristic protected by law. Accommodation is available upon request for candidates taking part in the selection process. 'AXIS Insurance is seeking a talented and dynamic environmental/construction/surety claims professional to join our Design Professional & Environmental (DP&E) claims team as a Claims Specialist. This position will primarily handle environmental package policy claims arising from environmental contractors, specialty trade contractors, and professional services. Key Duties and Responsibilities: o Conducts investigations to determine liability, damages, and coverage. o Makes recommendations regarding resolution strategy for such claims including reserve adequacy; executes such strategy on behalf of the company, with or without the help of outside counsel. o Excels in best practices claim environment, thoroughly documenting the claim process. o Analyzes liability and damages issues in connection with complex primary and excess claims and maintaining appropriate documentation. o Timely make recommendations regarding resolution strategy for claims including reserve adequacy. o Analyzes insurance coverage issues and timely draft coverage letters. o Collaborates in the defense and resolution of claims. o Evaluates and maintain full pending claims diary in connection with the posting and maintaining of accurate reserves. o Maintains and develops relationships with brokers, risk managers and general counsels, and a variety of vendors. o Provides data and analytic based-informational support to underwriters. o Provides support to underwriters with respect to marketing efforts, policy wording, and trending discussions. o Participate in mediations and trials as required and travel if necessary. o Other duties as assigned. Required Education, Experience and Attributes: o A Juris Doctor degree from an accredited law school or equivalent work experience. o 4+ years of experience involving environmental liability claims, either in house or in private practice. o Demonstrated ability to work as part of a team, interact with others, meet deadlines, and successfully perform in a fast-paced, changing work environment. Other Desired Skills & Characteristics * Proficiency in Excel * Proficient in drafting coverage correspondence, experience in writing coverage letter, and other reporting communications. * Excellent negotiation, communication, and interpersonal skills (1) Location: New York, Red Bank, Alpharetta, or Chicago (2) Hybrid Work Environment - 3 Days in Office (3) State Adjuster licenses where required
    $91k-108k yearly est. 19d ago
  • Cyber Adjuster Claims Specialist II

    Everest National Insurance Company 4.2company rating

    Claim Processor Job In Warren, NJ

    Everest Insurance Company, a member of Everest Re Group, Ltd., is seeking an experienced Claims Professional to join our Cyber Claims Department, located in our New York City office. The Everest Cyber Claims Department is part of Everest Financial & Specialty Lines Claims and is a rapidly growing and collaborative group. The ideal candidate should possess the ability to handle Cyber claims. More particularly, the ideal candidate will be able to analyze insurance coverage issues and resolve claims according to certain Best Practices and within stated authority limits. This position will report to the Director of Cyber Claims. Responsibilities include, but are not limited to: intake, investigate, determine coverage, manage and resolve Cyber, Privacy, Media and Tech E&O claims Review and analyze complex coverage issues and preparation of coverage position letters Handle demanding and complex first party Cyber Claims, including Data Breaches, Business Interruption, Contingent Business Interruption, and Extortion claims Handle third party privacy liability, PCI, Regulatory, Media and Tech E&O claims, resolving claimseffectively and efficiently Assist with emergencies on a rotational on-call schedule Management and review of budgets, restoration plans and Business Interruption Income Proofsof Loss Investigation, analysis and evaluation of liability and damages Management and direction of outside counsel as well as reviewing & approving legal budgets and bills Preparation of case summary reports related to matters of significant reserve and trial activity Timely and appropriate setting of case reserves Development and execution of claim strategies as well as resolution strategies Negotiation and resolution of cases Attend mediations Working with underwriters supporting policy construction and drafting, reporting claim trends,data analysis and risk assessment Extensive communication with insureds, brokers, reinsurers and business unit contacts Attend client meetings and industry functions to support retention and development of clientrelationships and business Skills Relevant experiences: A broad Insurance experience, including understanding of policy language, coverages, ethics and claim practices. Legal experience, including litigation, class action,regulatory, breach response, coverage would also be helpful. Cyber experience or understanding, including computer security, forensics, and network restoration, would also be helpful. Multi-tasking and prioritization skills Persuasive and efficient writing Legal and insurance claim resolution skills, including negotiations Accounting Data analysis Quick learning Collaboration Independence Problem solving MS Office Suite and ability to learn constantly improving programs Work Experience & Qualifications: The ideal candidate will have 3-5 years of professional liability claims experience. Strong oral andwritten communication skills Strong analytical and organizational skills Strong negotiation and investigation skills Excellent interpersonal skills Ability to evaluate coverage issues involving a wide variety of loss scenarios Ability to think strategically In-depth knowledge of the litigation, arbitration, and trial process Currently holds or readily can obtain all required adjuster licenses Knowledge of the insurance industry, claims and the insurance legal and regulatory environment Knowledge of claims handling or insurance legal statutes and procedures Ability to identify and use relevant data and metrics to best manage claims Collaborative mind-set and willingness to work with people outside immediate reportinghierarchy to improve processes and generate optimal departmental efficiency Our Culture At Everest, our purpose is to provide the world with protection. We help clients and businesses thrive, fuel global economies, and create sustainable value for our colleagues, shareholders and the communities that we serve. We also pride ourselves on having a unique and inclusive culture which is driven by a unified set of values and behaviors. Click here to learn more about our culture. Our Values are the guiding principles that inform our decisions, actions and behaviors. They are an expression of our culture and an integral part of how we work: Talent. Thoughtful assumption of risk. Execution. Efficiency. Humility. Leadership. Collaboration. Diversity, Equity and Inclusion. Our Colleague Behaviors define how we operate and interact with each other no matter our location, level or function: Respect everyone. Pursue better. Lead by example. Own our outcomes. Win together. All colleagues are held accountable to upholding and supporting our values and behaviors across the company. This includes day to day interactions with fellow colleagues, and the global communities we serve. For NY Only: The base salary range for this position is $120,000 - $160,000 annually. The offered rate of compensation will be based on individual education, experience, qualifications and work location. Type: Regular Time Type: Full time Primary Location: Warren, NJ Additional Locations: New York, NY Everest is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex (including pregnancy), sexual orientation, gender identity or expression, national origin or ancestry, citizenship, genetics, physical or mental disability, age, marital status, civil union status, family or parental status, veteran status, or any other characteristic protected by law. As part of this commitment, Everest will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Everest Benefits at *********************************. Everest U.S. Privacy Notice | Everest (everestglobal.com)
    $120k-160k yearly Easy Apply 60d+ ago
  • Claims Specialist

    Information Security 3.8company rating

    Claim Processor Job In Berkeley Heights, NJ

    We are seeking talented and enthusiastic individuals to proactively investigate and directly handle Professional Liability Claims, including but not limited to, Lawyers, Accountants, Architects & Engineers and Insurance Agents & Brokers. Minimum of 2-3 years of Professional Liability claims handling experience and/or applicable legal experience. Juris Doctor degree preferred. Prior claims leadership/management experience a plus. Adjuster's licenses preferred or must be willing to obtain upon starting. Excellent written, verbal, and interpersonal communication skills. Strong analytic, investigative, listening, and negotiation skills. A desire to be part of a team. Keen attention to detail. Ability and willingness to travel as needed. #WSP Be responsible for a pending of primary and excess Professional Liability claims from first notice through resolution, including coverage evaluation and litigation management. Provide top-notch customer service through all interactions and communications including with internal and external customers and business partners. Work collaboratively with internal and external business partners, including underwriters, actuaries, brokers, insureds, counsel, and senior management. Use your negotiation skills at mediations and settlement conferences. Identify and communicate industry trends. Adhere to all statutory regulations and Unfair Claims Practices Acts.
    $80k-129k yearly est. 12d ago
  • Regional Claims Specialist (I/II/Sr.)

    New Jersey Manufacturers Ins 4.7company rating

    Claim Processor Job In Trenton, NJ

    NJM's Workers' Compensation Claims Team is seeking a Regional Claims Specialist (I/II/Sr.). This is a full-time position and offers a hybrid schedule after training. The Regional Claims Specialist 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 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 role is based in our NJM's West Trenton office location. Hours: Monday to Friday 8:00AM- 4:15PM (Hours can very depending on start time). 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 Manage litigated claims through with proactive execution of action plans to resolve claim issues to move cases toward closure and reduce aged inventory 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. Determine compensability and coverage issues that have been placed in litigation 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 Assign and refer claim petitions to Counsel, and work to resolve the claim within given authority 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 for Claim Reviews; attend and participate as needed with the Claims Team and Supervisor 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: Level I- 1-3 years' experience as a Workers' Comp Claim Representative, or comparable knowledge and experience with various aspects of claims handling and/or process including strong knowledge of WC Law, medical terminology, and utilization of an automatic claims processing system. Level II- 3-5 years' experience as a Workers' Comp Claim Representative, or comparable knowledge and experience with various aspects of claims handling and/or process including strong knowledge of WC Law, medical terminology, and utilization of an automatic claims processing system. Sr Level - 5+ years' experience as a Workers' Comp Claim Representative, or comparable knowledge and experience with various aspects of claims handling and/or process including advanced knowledge of WC Law, medical terminology, and utilization of an automatic claims processing system. Knowledge of WC regulations and jurisdiction(s) to be able to formulate a Plan of Action to bring claims to resolution Knowledge of and experience working Work with 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 Working 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% Preferred: Multi-state experience and/or licensing (including NJ, MD, CT, DE, PA and/or NY) Associate's or Bachelor's degree AIC/CPCU Designations Salary: The position can be filled at a I, II, or Sr. level. Salary is commensurate with experience and credentials. Level I- $57K+ annually based on experience and credentials Level II - $65K+ annually based on experience and credentials Sr Level - $79K+ annually based on experience and credentials Benefits Offered: Medical Insurance (Blue Cross Blue Shield) Dental Insurance (Delta Dental) Vision (Delta Vision/ VSP) Flexible Spending Account Discounts on NJM auto insurance Tuition reimbursement Life insurance Plus, additional company discounts for items like travel, service, car rental and more! 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.
    $57k-79k yearly 11d ago
  • Claims Specialist, Motor Truck Cargo/Ocean Marine

    CNA Financial Corp 4.6company rating

    Claim Processor Job In Warren, NJ

    You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. This individual contributor position works under moderate direction, and within defined authority limits, to manage primarily motor truck cargo claims with moderate to high complexity and exposure. There may also be opportunity to handle ocean marine claims. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific account(s). JOB DESCRIPTION: Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: * Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. * Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information. * Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters, estimating potential claim valuation, and following company's claim handling protocols. * Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim. * Establishes and maintains working relationships with appropriate internal and external work partners, suppliers and experts by identifying and collaborating with resources that are needed to effectively resolve claims. * Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate. * Contributes to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service. * Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU resources for further investigation. * Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements. * Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business. * May serve as a mentor/coach to less experienced claim professionals May perform additional duties as assigned. Reporting Relationship Typically Manager or above Skills, Knowledge & Abilities * Solid working knowledge of motor truck cargo claims handling, liability analysis, policy coverage and claim practices. * Solid verbal and written communication skills with the ability to develop positive working relationships, summarize and present information to customers, claimants and senior management as needed. * Demonstrated ability to develop collaborative business relationships with internal and external work partners. * Ability to exercise independent judgement, solve moderately complex problems and make sound business decisions. * Demonstrated investigative experience with an analytical mindset and critical thinking skills. * Strong work ethic, with demonstrated time management and organizational skills. * Demonstrated ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity. * Developing ability to negotiate low to moderately complex settlements. * Adaptable to a changing environment. * Knowledge of Microsoft Office Suite and ability to learn business-related software. * Demonstrated ability to value diverse opinions and ideas Education & Experience: * Bachelor's Degree or equivalent experience. * Typically a minimum four years of relevant experience, preferably in claim handling. * Candidates who have successfully completed the CNA Claim Training Program may be considered after 2 years of claim handling experience. * Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable. * Professional designations are a plus (e.g. CPCU) #LI-AR1 #LI-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Maryland, New York and Washington, the national base pay range for this job level is $49,000 to $98,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.
    $49k-98k yearly 44d ago
  • RCO-Advanced Claims Review Specialist

    Pharmscript 4.4company rating

    Claim Processor Job In Somerset, NJ

    Overview PharmScript is one of the nation's leading pharmacies, partnering with long-term and post- acute care facilities to supply medications to thousands of residents and patients. When you join the PharmScript family, you join the ranks of more than 2,000 dedicated people across the country who help to get safe, accurate, and timely medication to those who need it most. Job Summary We're looking for an Advanced Claims Review Specialist to join our PharmScript team within our Revenue Cycle Operations department. As an Advanced Claims Review Specialist, the ideal candidate responsible for workflow - submitting retro rebilling claims to Medicare, Medicaid, and Private Insurances for reimbursement while performing other clerical duties as necessary. The ideal candidate is a people person who enjoys troubleshooting and resolving problems and is dedicated to helping customers. For you, no task feels too small and no challenge impossible. Excellent communication and interpersonal skills are essential. Responsibilities Responsible for workflow- submitting retro re billing claims to Medicare, Medicaid, and Private Insurances for reimbursement both via electronic and hard copy methods in timely manner Responsible to communicate with facilities regarding all items that are non-covered by an insurance due to retro re billing that have covered alternatives and where allowed file prior Prioritize your work activities daily Timely response to all customer inquiries, both inbound and outbound prior Responsible for working with nursing facilities/customer service representative to review charges related insurance Qualifications High school degree Must possess or be willing to apply for NJ Pharmacy Technician license Previous experience working with Long-term care facilities preferred Able to work independently as well as in a diverse, team environment Reliable, able to work under pressure and meet deadlines Excellent communication skills, professional demeanor Must have flexibility to work evenings/weekends (2nd / 3rd Shift) Knowledge of Medicare Part D, Medicaid, Medicaid HMO plans, & commercial insurances Familiarity with resolving Insurance rejections for prescriptions such as refill too soon, Prior Authorization and Non-Covered items Physical Demands and Work Environment The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job: May sit or stand seven (7) to ten (10) hours per day The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, crouch, walk, crawl intermittently May be necessary to work extended hours as needed May lift and/or move up to 25 pounds The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role Knowledge, Skills, and Abilities Able to identify and resolve issues quickly and efficiently Excellent communication, problem solving and organizational skills Comfortable working independently as well as in a diverse, team environment Able to work under pressure and meet deadlines Strong customer service skills Ability to lift and/or move up to 25 pounds Strong analytical problem solving and strategic thinking skills Excellent interpersonal skills Basic computer skills and proficient in Microsoft Office Moderate to advanced computer skills required Ability to work at a moderate speed Must possess strong telephone communication skills and etiquette Detail oriented, excellent organizational skills We Offer PharmScript offers a robust suite of benefits to support employees and their families. Health and Wellness Benefits Medical, Prescription Drug, Dental, and Vision coverage for you and your eligible dependents Maternity care program and infertility services Tax-favored Health Savings Accounts, Healthcare, and Dependent Care Flexible Spending Accounts. EAP Assistance Program with 24/7 access to free counseling, legal guidance, and financial resources Paid Time Off and Holidays 15 PTO days annually and 6 paid/floating holidays Retirement Planning 401(k) retirement planning with company match Commuter Benefits Transit/Parking Spending Account Voluntary Benefits Employee Life and Accidental Death & Dismemberment, Short/Long-term Disability, Critical Illness, Accident, and Hospital Indemnity plans are available for you and eligible dependents, Other Perks and Benefits Legal & Identity Theft Protection Programs Employee Discounts: Instant savings on hundreds of products and services Pet Insurance Employee Support Program to eligible employees in times of urgent need Pay Transparency To reinforce our commitment to fair and equal pay transparency, PharmScript's compensation is based on multiple non-discriminatory, individualized factors including but not limited to experience, job-related knowledge, education, skills, and office/market location. EEO Statement PharmScript is fully committed to employing a diverse workforce. We recruit and retain talented individuals without regard to gender, race, age, marital status, disability, veteran status, sexual orientation and gender identity or any other status protected by federal, state, or local law. EO/Minorities/Females/Disabled/Veterans Min USD $18. 00/Hr. Max USD $20. 00/Hr.
    $40k-67k yearly est. 18d ago
  • ESIS Claims Specialist, WC

    Chubb 4.3company rating

    Claim Processor Job In Philadelphia, PA

    The Workers' Compensation Senior Claims Representative, under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines. MAJOR DUTIES & RESPONSIBILITIES: Duties may include but are not limited to: Receive assignments. Reviews claim and policy information to provide background for investigation and may determine the extent of the policy's obligation to the insured depending on the line of business. Contacts, interviews, and obtains statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information. Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company's obligation to the insured under the policy contract. Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc. Sets reserves within authority limits and recommends reserve changes to Team Leader. Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions. Prepares and submits to Team Leader unusual or possible undesirable exposures. Assists Team Leader in developing methods and improvements for handling claims. Settles claims promptly and equitably. Obtains releases and timely issues indemnity benefits if due and owing. Informs claimants, insureds/customers, or attorney of denial of claim when applicable. May assist Team Leader and company attorneys in preparing cases for trial by taking statements. Continues efforts to settle claims before trial. Refers claims to subrogation as appropriate. May participate in claim file reviews and audits with customer/insured and broker. Administers Workers' Compensation benefits timely and appropriately per Jurisdiction. Maintains control of claim's resolution process to minimize current exposure and future risks Establishes and maintains strong customer relations OTHER DUTIES MAY INCLUDE: Working all queues and diary in a timely manner Investigating compensability and benefit entitlement Reviewing and approving medical bill payments Managing vocational rehabilitation DESIRED QUALIFICATIONS: 5-7 years' experience handling Workers' Compensation claims Knowledge of claims handling and familiarity with claims terminologies Effective negotiation skills Strong communication and interpersonal skills to be capable of dealing with claimants, customers, insureds, brokers, attorneys etc. in a positive manner concerning losses. Ability to self-motivate and work independently, excels in organization and time management skills Knowledge of company products, services, coverages, and policy limits, along with awareness of the company's claims best practices and client service instructions Knowledge of applicable state and local laws. ESIS, a multi-line Third-Party Administrator (TPA), provides claims, risk control & loss information systems to Fortune 1000 clients across its North American platform. ESIS provides a full range of sophisticated risk management services, including workers compensation claims handling; a broad spectrum of casualty insurance products, such as general liability, automobile liability, products liability, professional liability, and medical malpractice claims handling; and disability management. The Workers' Compensation Senior Claims Representative, under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines. MAJOR DUTIES & RESPONSIBILITIES: Duties may include but are not limited to: Receive assignments. Reviews claim and policy information to provide background for investigation and may determine the extent of the policy's obligation to the insured depending on the line of business. Contacts, interviews, and obtains statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information. Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company's obligation to the insured under the policy contract. Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc. Sets reserves within authority limits and recommends reserve changes to Team Leader. Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions. Prepares and submits to Team Leader unusual or possible undesirable exposures. Assists Team Leader in developing methods and improvements for handling claims. Settles claims promptly and equitably. Obtains releases and timely issues indemnity benefits if due and owing. Informs claimants, insureds/customers, or attorney of denial of claim when applicable. May assist Team Leader and company attorneys in preparing cases for trial by taking statements. Continues efforts to settle claims before trial. Refers claims to subrogation as appropriate. May participate in claim file reviews and audits with customer/insured and broker. Administers Workers' Compensation benefits timely and appropriately per Jurisdiction. Maintains control of claim's resolution process to minimize current exposure and future risks Establishes and maintains strong customer relations OTHER DUTIES MAY INCLUDE: Working all queues and diary in a timely manner Investigating compensability and benefit entitlement Reviewing and approving medical bill payments Managing vocational rehabilitation DESIRED QUALIFICATIONS: 5-7 years' experience handling Workers' Compensation claims Knowledge of claims handling and familiarity with claims terminologies Effective negotiation skills Strong communication and interpersonal skills to be capable of dealing with claimants, customers, insureds, brokers, attorneys etc. in a positive manner concerning losses. Ability to self-motivate and work independently, excels in organization and time management skills Knowledge of company products, services, coverages, and policy limits, along with awareness of the company's claims best practices and client service instructions Knowledge of applicable state and local laws. ESIS, a multi-line Third-Party Administrator (TPA), provides claims, risk control & loss information systems to Fortune 1000 clients across its North American platform. ESIS provides a full range of sophisticated risk management services, including workers compensation claims handling; a broad spectrum of casualty insurance products, such as general liability, automobile liability, products liability, professional liability, and medical malpractice claims handling; and disability management. An applicable resident or designated home state adjuster's license is required for ESIS Field Claims Adjusters. Adjusters that do not fulfill the license requirements will not meet ESIS's employment requirements for handling claims. ESIS supports independent self-study time and will allow up to 4 months to pass the adjuster licensing exam.
    $92k-120k yearly est. 1d ago
  • Claims Specialist

    Westfield 3.3company rating

    Claim Processor Job In Berkeley Heights, NJ

    We are seeking talented and enthusiastic individuals to proactively investigate and directly handle Professional Liability Claims, including but not limited to, Lawyers, Accountants, Architects & Engineers and Insurance Agents & Brokers. Minimum of 2-3 years of Professional Liability claims handling experience and/or applicable legal experience. Juris Doctor degree preferred. Prior claims leadership/management experience a plus. Adjuster's licenses preferred or must be willing to obtain upon starting. Excellent written, verbal, and interpersonal communication skills. Strong analytic, investigative, listening, and negotiation skills. A desire to be part of a team. Keen attention to detail. Ability and willingness to travel as needed. #WSP Be responsible for a pending of primary and excess Professional Liability claims from first notice through resolution, including coverage evaluation and litigation management. Provide top-notch customer service through all interactions and communications including with internal and external customers and business partners. Work collaboratively with internal and external business partners, including underwriters, actuaries, brokers, insureds, counsel, and senior management. Use your negotiation skills at mediations and settlement conferences. Identify and communicate industry trends. Adhere to all statutory regulations and Unfair Claims Practices Acts.
    $40k-45k yearly est. 12d ago
  • Claims Specialist

    Westfield Group, Insurance

    Claim Processor Job In Berkeley Heights, NJ

    We are seeking talented and enthusiastic individuals to proactively investigate and directly handle Professional Liability Claims, including but not limited to, Lawyers, Accountants, Architects & Engineers and Insurance Agents & Brokers.
    $45k-79k yearly est. 28d ago
  • Claims Representative, Casualty

    Plymouth Rock Assurance 4.7company rating

    Claim Processor Job In Mount Laurel, NJ

    The Casualty Claim Representative will be responsible for the handling of First and Third Party Bodily Injury claims in a Personal Lines/Commercial environment for the Plymouth Rock Operation. Essential Functions and Responsibilities Initiate prompt contact of all insureds/claimants/witnesses on all new claim assignments to conduct thorough coverage and liability/injury investigations. These investigations might require the representatives take in depth recorded statements to investigate coverage and liability/injury claims. Analyze, review and interpret policies to assess coverage and liability. Provide advice to Excess and Primary coverage issues. Conduct field investigations, interviews with insureds, witnesses and claimants while maintaining a pending of represented and unrepresented claimant cases. Manage and direct outside vendors (Field/Counsel/Surveillance, etc.) to determine what investigation is necessary and give them direction to bring a claim to conclusion. Ensure only necessary work is completed. Investigate cases timely so that reserves are established and maintained at proper levels. Revise reserves timely based on developments in the course of the claim. Investigate the validity of bodily injury claims being presented by individual insureds/claimants or attorneys representing insureds/claimants. Be aware of certain “Red Flags” to identify potential fraudulent claims. Refer to SIU for investigation timely. Handle complex claims to include coverage issues, UM/UIM, TNC, Commercial, Umbrella etc. Also, must have prior litigation handling. Recognize and investigate subrogation potential. Negotiate both 1st and 3rd party claims directly with injured parties and/or their attorneys. Exercises proper judgment and decision making to analyze exposure, determine the proper course of action and make recommendations for final resolution. Attend litigation proceedings to either represent the company or participate in arbitrations/depositions/settlement conferences/ mediations/ trials. Attend all internal and external training events as required. Participate in proactive team activities to achieve departmental and company objectives. May be asked to participate in special projects, committees or assignments from management. Utilize all claims systems, Excel, Word and social media search engines. Prepare case summary for significant reserve increase and/or trial alerts. Participate in roundtable discussions. Effectively manage workload while maintaining diary and focus on claims quality. Possess knowledge of and adherence to State(s) laws and regulatory claim handling guidelines and statutory regulations. Adhere to departmental internal control requirements. Comply with Plymouth Rock's standards, best practices and ethical guidelines, adhere to Plymouth Rock's culture. Qualifications and Education A bachelor's degree (B.A.) from an accredited four year college or university. 5 - 10 years' experience handling liability commercial, homeowners, UM/UIM, Excess/Umbrella. In-depth knowledge of litigation, arbitration and trial process, handle out of state claims, and/or Personal Injury Protection claims. Currently holds and/or can readily obtain an out of State License(s) (i.e. - CT, Delaware, Florida, etc.). Professional designation such as IIA, AEI, Senior Claim Law Associate (SCLA) or Chartered Property Casualty Underwriting (CPCU) or be actively working towards a designation, preferred. High level of self-motivation. Have advanced skills in coverage, investigation, litigation/ legal issues, negotiations, evaluations, medical terminology, and subrogation. Strong communication, organizational, customer service and time management skills. Excellent problem solving skills. Possess knowledge of and adherence to State(s) laws and regulatory claim handling guidelines and statutory regulations. About the Company The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of “A-/Excellent”.
    $42k-53k yearly est. 11d ago
  • LTD Claims Examiner II

    Reliance Standard

    Claim Processor Job In Philadelphia, PA

    Job Responsibilities and Requirements KEY RESPONSIBILITIES *other duties as assigned* Obtains and analyzes information to make claim decisions and payments on LTD, Voluntary disability and Waiver of Premium claims. The goal of the position/role is to consistently render appropriate claim determinations based on a review of all available information and the terms and provisions of the applicable policy. Reviews and investigates disability claims by using telephone and written contact with the applicable parties, (claimant, employer/supervisor, credit union, treating physician, etc.) to gather pertinent data to analyze the claim. Adjudicates claims accurately and fairly in accordance with the contract, appropriate claim policies and procedures, and state and federal regulations, meeting productivity and quality standards based on product line. Utilizes appropriate medical and risk resources, adhering to referral polices, and transferring claims to the appropriate risk level in a timely manner. Conducts in-depth pre-existing condition or contestable investigations if applicable. Calculates benefit payments, which may include partial disability benefits, integration with other income sources, survivor benefits, residual disability benefits, etc. Develops and maintains on-line claim data (and paper file if applicable). Provide customer service that is respectful, prompt, concise, and accurate in an environment with competing demands. Analysis and Adjudication Fully investigates and adjudicates a large volume simple to complex claims. Identifies and investigates change in Total Disability definition (any occ). Independently reviews and manage claims with high degree of complexity within the $1,500 per month approval authority limit. Independently makes the determination if a policyholder with life policy up to $125,000 is eligible for a waiver of premium. Majority of work is not subject to supervisor review and approval. Case Management Consistently manage assigned case load of 60-80 simple to complex cases independently. Collaborates with team members and management in identifying and implementing improvement opportunities. REQUIRED KNOWLEDGE, SKILLS, ABILITIES, COMPETENCIES, AND/OR RELATED EXPERIENCE *or equivalent experience gained from any combination of formal education, on-the-job training, and/or work and life experience* Required Knowledge, Skills, Abilities and/or Related Experience High School Diploma or GED. Associates degree in Business, Finance, Social Work, or Human Resources preferred. Level I LOMA designation preferred. 2 years experience processing long term disability claims. Demonstrated understanding of claim management techniques and critical thinking in activities requiring analysis and/or investigation. Experience working in confidential/protected identification environments. Knowledge of medical terminology. Good math and calculation skills. Proven ability to work well in a high-visibility, public-oriented environment. Ability to Travel: None PHYSICAL REQUIREMENTS When used in the description below, the following terms are defined as: “Occasional”: done only from time to time, but necessary when it is performed “Frequent”: regularly performed; generally an act that is required on a daily basis “Continuous”: typically performed for the majority of an employee's shift Sitting for prolonged periods of time, frequently standing, walking distances up to one mile, bending, crouching, kneeling, reaching, occasionally lifting 25lbs, extensive typing, picking up and holding small objecting and otherwise using primarily the fingers rather than the entire hand. Employee is required to have visual acuity sufficient to perform activities such as preparing and analyzing data and figures; transcribing notes; viewing a computer terminal and extensive reading. Employee is required to have hearing sufficient to understand verbal instruction and answer telephones. Reliance Matrix will provide qualified employees with a reasonable accommodation in accordance with applicable law. CORE VALUES Collaboration Compassion Empowerment Integrity Fun The above description reflects the general details considered necessary to describe the principle responsibilities and functions of the job identified and shall not be construed as a detailed description of all the work requirements that may be inherent to this job. The expected hiring range for this position is $54,990.00 - $68,750.00 annually for work performed in the primary location (Philadelphia, PA). This expected hiring range covers only base pay and excludes any other compensation components such as commissions or incentive awards. The successful candidate's starting base pay will be based on several factors including work location, job-related skills, experience, qualifications, and market conditions. These ranges may be modified in the future. Work location may be flexible if approved by the Company. What We Offer At Reliance Matrix, we believe that creating a more diverse, equitable and inclusive culture allows us to realize more of our potential. And we can't do this without our most important asset-you. That is why we offer a competitive pay package and a range of benefits to help team members thrive in their financial, physical, and mental wellbeing. Our Benefits: An annual performance bonus for all team members Generous 401(k) company match that is immediately vested A choice of three medical plans (that include prescription drug coverage) to suit your unique needs. For High Deductible Health Plan enrollees, a company contribution to your Health Savings Account Multiple options for dental and vision coverage Company provided Life & Disability Insurance to ensure financial protection when you need it most Family friendly benefits including Paid Parental Leave & Adoption Assistance Hybrid work arrangements for eligible roles Tuition Reimbursement and Continuing Professional Education Paid Time Off, volunteer days, community partnerships, and Employee Assistance Program Ability to connect with colleagues around the country through our Employee Resource Group program and our Diversity Equity & Inclusion Council Our Values: Integrity Empowerment Compassion Collaboration Fun EEO Statement Reliance Matrix is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, national origin, citizenship, age or disability, or any other classification or characteristic protected by federal or state law or regulation. We assure you that your opportunity for employment depends solely on your qualifications. #LI-Remote #LI-MR1
    $55k-68.8k yearly 7d ago
  • Regional Claims Specialist (I/II/Sr.)

    NJM Insurance 4.7company rating

    Claim Processor Job In Trenton, NJ

    NJM's Workers' Compensation Claims Team is seeking a Regional Claims Specialist (I/II/Sr.). This is a full-time position and offers a hybrid schedule after training. The Regional Claims Specialist 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 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 role is based in our NJM's West Trenton office location. Hours: Monday to Friday 8:00AM- 4:15PM (Hours can very depending on start time). 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 + Manage litigated claims through with proactive execution of action plans to resolve claim issues to move cases toward closure and reduce aged inventory + 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. + Determine compensability and coverage issues that have been placed in litigation 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 + Assign and refer claim petitions to Counsel, and work to resolve the claim within given authority + 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 for Claim Reviews; attend and participate as needed with the Claims Team and Supervisor + 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: + Level I - 1 -3 years' experience as a Workers' Comp Claim Representative, or comparable knowledge and experience with various aspects of claims handling and/or process including strong knowledge of WC Law, medical terminology, and utilization of an automatic claims processing system. + Level II - 3-5 years' experience as a Workers' Comp Claim Representative, or comparable knowledge and experience with various aspects of claims handling and/or process including strong knowledge of WC Law, medical terminology, and utilization of an automatic claims processing system. + Sr Level - 5+ years' experience as a Workers' Comp Claim Representative, or comparable knowledge and experience with various aspects of claims handling and/or process including advanced knowledge of WC Law, medical terminology, and utilization of an automatic claims processing system. + Knowledge of WC regulations and jurisdiction(s) to be able to formulate a Plan of Action to bring claims to resolution + Knowledge of and experience working Work with 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 + Working 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% Preferred: + Multi-state experience and/or licensing (including NJ, MD, CT, DE, PA and/or NY) + Associate's or Bachelor's degree + AIC/CPCU Designations Salary: The position can be filled at a I, II, or Sr. level. Salary is commensurate with experience and credentials. + Level I- $57K+ annually based on experience and credentials + Level II - $65K+ annually based on experience and credentials + Sr Level - $79K+ annually based on experience and credentials Benefits Offered: + Medical Insurance (Blue Cross Blue Shield) + Dental Insurance (Delta Dental) + Vision (Delta Vision/ VSP) + Flexible Spending Account + Discounts on NJM auto insurance + Tuition reimbursement + Life insurance + Plus, additional company discounts for items like travel, service, car rental and more! 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.
    $57k-79k yearly 15d ago

Learn More About Claim Processor Jobs

How much does a Claim Processor earn in Lawrence, NJ?

The average claim processor in Lawrence, NJ earns between $28,000 and $88,000 annually. This compares to the national average claim processor range of $26,000 to $62,000.

Average Claim Processor Salary In Lawrence, NJ

$49,000

What are the biggest employers of Claim Processors in Lawrence, NJ?

The biggest employers of Claim Processors in Lawrence, NJ are:
  1. Sedgwick LLP
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