Responsibility includes effective and timely communication with employer, employee, and medical provider.
Effective and consistent partnership with nurse management to return injured worker back to gainful employment; administration of benefits, litigation management and claim resolution, and handling.
All job duties and responsibilities must be carried out in compliance with applicable legal and regulatory requirements.
Receives assigned claims for medical and disability management. Processes claims which include the following activities: set up file in ACS, establish initial reserves, analyze investigational data, settle claims, reserve claim for probable ultimate payout, explore subrogation potential, closes claims and secures appropriate releases. Documents claims files and maintain control of work through documentation or diary system. Assigns litigated claims to an attorney who manages defense claim. File state forms timely in accordance with statutory guidelines. Assign nurse case management or other experts to case and arrange when necessary. Prepare for and participate in claims review and settlement conferences. Ensures compliance with company, state and federal regulations. Jurisdictional knowledge of New Jersey is preferred, but not required.
Knowledge of workers compensation statutes, coverage and case law. Excellent written and verbal communication skills. Critical thinking skills to assess compensability of WC claim as it relates to the facts and law.
College degree preferred.
3 - 5 years claims experience preferred.
1-2 years appraisal experience preferred.
1 year data entry experience preferred.
Selective is an Equal Employment Opportunity employer. Selective maintains a drug-free workplace.