Complex Claims Supervisor Job Listing at NJM Insurance Group in Trenton, NJ (Job ID R2007322)

Description

The Complex Claims Supervisor will utilize their knowledge of Workers' Compensation Claims to guide staff on complex and high severity claims involving quality medical care and rehabilitation. This position will supervise claims staff and provide support to ensure achievement of appropriate claim outcomes through consistent execution of best claims practices.

Hours:

• Monday-Friday, specific hours are subject to selected start time between 8am-9am pending supervisory approval

This opportunity can be based out of the NJM- Hammonton or Trenton office. Travel to the NJM- Hammonton office will be required on certain days.

Essential Duties and Responsibilities:

• Develop, recommend, and implement departmental objectives consistent with company business goals, guidelines, and programs

• Assist with developing and executing strategic and operational goals and objectives for the WCC department

• Recommend process improvement where applicable to best improve the department and staff's efficiency, work product, and service commitment to interested parties

• Utilize quality assurance and KPI reports to effectively maximize performance, identify, and correct performance issues, and provide staff development opportunities

• Lead team meetings and facilitate training, inclusive of one-one staff meetings to ensure and coach to staff success and promote effective communication with employees

• Direct claims staff through technical aspects of complex and high severity medical (and CAT) claims for quality outcomes and return to work opportunities where able

• Recognize and investigate subrogation opportunity for recovery of third party funds and direct staff to pursue further information 

• Ensure quality management of claims in accordance with claims best practices and company guidelines, and timely, accurate documentation of claim activity

• Promptly manage technically complex and high exposure medical cases with minimal supervision

• Ensure appropriate case reserves for 90 Day and Credit Reviews consistent with company guidelines

• Work with complex legal issues while staying focused on managing those issues to the appropriate financial outcome

• Develop strategies and work collaboratively with vendor partners to encourage cost containment and positive case outcomes

• Provide technical direction and ongoing guidance to staff through effective diary and workplan management

• Assist staff with preparation, attendance, and conducting Claim Reviews with customers and brokers

• Apply critical thinking skills and multiple perspectives to different situations and strategically consider a systematic way to mitigate exposures by collaborating with staff and establishing a plan of action

• Collaborate with internal resources such as NJM legal staff, SIU, and MSA to successfully resolve and/or settle cases in a timely fashion

• Partner with Claim Account teams to manage large account (assignments) and develop rapport, trust, and manage expectations of servicing requirements

• Assist staff with preparation, attendance, and conducting Claim Reviews with customers and brokers

• 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:

• Bachelor's degree and/or five to eight years of equivalent work experience preferred in an insurance related industry required

• 5 to 8 years claims handling experience

• Knowledge of Workers' Compensation rules and regulations regarding compensability and causal relationship to provide guidance to claim staff

• Knowledge of claims regulations and applicable case law

• Sound knowledge of complex medical and claim handling techniques and medical terminology

• Excellent verbal and written communication skills

• Demonstrated leadership, coaching, mentoring and teamwork skills

• Critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details

• Experience utilizing an automated claim processing system and the Microsoft Office suite of tools (Word, Excel, PowerPoint)

• Strong organization skills with the ability to work independently and prioritize responsibilities

• Strong ability to communicate and work collaboratively with all stakeholders

• Ability to travel occasionally for business purposes

Preferred Qualifications:

• Previous experience in a leadership position with proven record of successful team building, goal achievement, and superior customer service

• Multi-state experience and/or licensing (including MD, CT, DE, PA and/or NY)

• Professional designations (CPCU, ARM, AIC, etc.)

Compensation: Salary is commensurate with experience and credentials.

Eligible full-time employees receive a competitive Total Rewards package, including but not limited to a 401(k) with employer match up to 8% and additional service-based contributions, Health, Dental, and Vision insurance, Life and Disability coverage, generous PTO, Paid Sick Leave, and paid parental leave in addition to state-mandated leave. Employees may also be eligible for discretionary bonuses.

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.