Workers' Claim Adjuster; NJ

Overview

Position Title: Workers’ Compensation Claim Adjuster (NJ focus)

Location: Hybrid (Reporting to Linwood, NJ)

Schedule: Monday – Friday | 8:00 AM – 4:30 PM EST

Salary Range: $65,000 – $70,000

At CCMSI
, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self‑insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee‑Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts. Certified as a Great Place To Work, our employee satisfaction and retention ranks in the 95th percentile.

• Culture:
  Our Core Values are embedded into our culture of how we treat our employees as a valued partner‑with integrity, passion and enthusiasm.
• Career development: CCMSI offers robust internships and internal training programs for advancement within our organization.
• Benefits:
  Not only do our benefits include 4 weeks paid time off in your first year, plus 10 paid holidays, but they also include Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP.
• Work Environment:
  We believe in providing an environment where employees enjoy coming to work every day, are provided the resources needed to perform their job and claims staff are assigned manageable caseloads.

The Workers’ Compensation Claim Consultant (Adjuster) is responsible for the investigation and adjustment of assigned claims. This adjuster will focus on New Jersey claims. This position may be used as an advanced training position for consideration of promotion to a more senior level claim position. Accountable for the quality of claim services as perceived by CCMSI clients and within our corporate claim standards.

• Investigate, evaluate and adjust claims in accordance with established claim handling standards and laws.
• Establish reserves and/or provide reserve recommendations within established reserve authority levels.
• Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated claims. Negotiate any disputed bills or invoices for resolution.
• Authorize and make payments of claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.
• Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate.
• Assist in the selection, referral and supervision of designated claim files sent to outside vendors (i.e. legal, surveillance, case management, etc.).
• Assess and monitor subrogation claims for resolution.
• Review and maintain personal diary on claim system.
• Client satisfaction.
• Prepare reports detailing claim status, payments and reserves, as requested.
• Compute disability rates in accordance with state laws.
• Effective and timely coordination of communication with clients, claimants and appropriate parties throughout the claim adjustment process.
• Prepare newsletter articles, as requested.
• Provide notices of qualifying claims to excess/reinsurance carriers.
• Handle more complex and involved claims than lower level claim positions with minimum supervision.
• Conduct claim reviews and/or training sessions for designated clients, as requested.
• Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.
• Compliance with Corporate Claim Handling Standards and special client handling instructions as established.

• Education and/or
  
  Experience:
  
  Five or more years claims experience is required. Bachelor’s degree is preferred.
• Computer
  
  Skills:
  
  Proficient using Microsoft Office products such as Word, Excel, Outlook, etc.
• Certificates, Licenses, Registrations: Adjuster's license may be required based on jurisdiction.
• Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the…