C. WinChell Agency
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Job Code:

20898
Category:

Workers Compensation Claims
State:

NJ

Title:

Senior Claim Specialist - Workers Compensation

Contact Phone:

(570) 839-1280

Base Pay Low:

$75,000

Base Pay High:

$85,000

Benefits:

Benefits

City:

Parsippany Area

Description:

Examine claims data and conduct investigations into routine and moderately complex claims to determine coverage, compensability, subrogation and benefits under moderate supervisory direction. Adjust and manage claims within the limit of assigned authority. Receive lost time and complex medical only assignments for the state of NY. Verify and determine applicability of coverage. Initiate 24 hour contact with employer, employee and 48 hour contact with attending physician. Handle catastrophic claims with supervisory oversight. Conduct telephone investigations. Evaluate and adjust claims within the limits of authority. Consult with Claim Manager on claims when needed. Make assignments to nurse case management when indicated, monitoring their billing and performance. Set reserves for anticipated exposure up to authority limits. Complete mandatory RAW forms. Establish reserves requiring complex analysis with lifetime pharmacy and cost inflation. Coordinate return to work (RTW) and set target dates. Maintain diaries on maximum 3 month intervals. Document files in claims system. Review medical bills for causal relationship, medical bill charges for appropriateness and approve payments. Adhere to special account handling (SHI) instructions. Attend account meetings by telephone and in-person. Manage litigation on files.

Requirement:

Must be well versed in New York Workers Compensation statute. Bachelor’s Degree or equivalent experience. Minimum 8+ years experience handling New York workers compensation claims. Strong organizational and time management skills. Foreign language communications a plus. Excellent verbal and written communication skills are essential. Strong aptitude and knowledge of Microsoft Office and the ability to quickly learn new programs. Abide by departmental policies and procedures, including authority levels, to comply with risk management controls.


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