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This is an exceptional opportunity to litigate a variety of workers’ compensation claims involving high-exposure, complex litigation. In return, our Wilmington workers’ compensation team provides a diverse, inclusive, open-door environment where colleagues collaborate to proactively and innovatively defend our clients.
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NJM's Workers' Compensation Claims Team is seeking an experienced Complex Claim Specialist. Proactively manage the technical aspects of complex and high severity medical and CAT claims for quality outcomes and return to work opportunities under the regular guidance of Complex Claims Supervisor.
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Manage Workers' Compensation claims with lost time to conclusion and negotiate settlements where appropriate to resolve claims. The claim involves moderate to complex litigation issues IW has returned to work, reached Maximum Medical Improvement (MMI), and has PPD. File litigated to dispute the permanency rating and/or causality.
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Communicates with internal managed care and medical resources to ensure coordination with medical providers, injured workers and employers in developing return to work strategies and treatment plans.
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Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments. Description: PRIMARY PURPOSE: To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.
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Independently handles assigned claims of low to moderate complexity where Wage loss and the expectation is a return to work to modified or full duty or obtain MMI with no RTW. There are no litigated issues or minor to moderate litigated issues.
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Requires a working knowledge of the Labor Code of the State of California as it pertains to workers compensation claims and the legal requirements for handling them. Form a partnership with the medical case manager to maximize early return to work potential thereby reducing the need for extended disability payments, vocational rehabilitation, and other protracted claims costs.
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Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
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Requires a high degree of claims handling expertise to include a minimum of at least five years experience managing indemnity cases, many with complex or high potential subrogation, rehabilitation, medical management, and/or legal issues & possess an SIP certificate.
$75,000 - $98,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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As a member of our claims team, utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes.
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The Workers' Compensation Claims Specialist is responsible for managing and processing claims related to workplace injuries or illnesses for a nationwide Professional Employer Organization (PEO.
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Work collaboratively with PMA nurse professionals to develop and execute return to work strategies. Provide a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account-specific sessions.
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Promptly investigate all assigned claims with minimal supervision, including those of a more complex nature. Alert Supervisor and Special Investigations Unit to potentially suspect claims.
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Work in collaboration with specialty resources ( medical and legal) to proactively pursue claim resolution opportunities, ( return to work, structured settlement, and discontinuation of benefits through litigation.
$63 - $105Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Under general supervision, manage Workers' Compensation claims with lost time to conclusion and negotiate settlements where appropriate to resolve claims. Independently handles all assigned claims up to and including most complex where Injured worker (IW) remains out of work and unlikely to return to position.
$65 - $108Full-timeExpandApply NowActive JobUpdated Today
workers compensation complex return to jobs
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