Workers' Compensation Claims Adjustor 2 - Coventry WCS

Company Overview:

The Enlyte Family of Businesses

Mitchell | Genex | Coventry

 

Enlyte is the parent brand of Mitchell, Genex and Coventry, an organization unlike any other in the Property & Casualty industry, bringing together three great businesses with a shared vision of using technology innovation, clinical services and network solutions to help our customers and the people they serve. Our suite of products and services enable our employees to help people recover from challenging life events, while providing opportunities for meaningful impact and career growth.

Job Description:

This position is a hybrid role and you must reside in New Jersey as you wil be tasked wth coming into office once a month.

 

· Maintains both Medical Only and Lost Time diary of New Jersey workers' compensation claims.  

· Evaluate claimant eligibility; communicate with attending physician, employer and injured worker.

· Work with both the claimant and their physician to medically manage the claim, from initial medical treatment to reviewing and evaluating ongoing treatment and related information.

· Work directly with employers to facilitate a return to work, either on a full-time or modified duty basis.

· Confirm coverage and applicable insurance policy or coverage document and statutory requirements.

· Identify potential for third party recovery, including subrogation, Second Injury Fund or other fund involvement (when applicable) and excess or reinsurance reimbursement. Pursue the process of reimbursement and complete posting of recovery to the claim file, where appropriate.

· Identify potential for disability or pension credits or offsets and apply same where appropriate.

· Ensure timely denial or payment of benefits in accordance with jurisdictional requirements.

· Establish claim reserve levels by estimating the potential exposure of each assigned claim, establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure.

· Establish compensability status through case investigation and evaluation and application of jurisdictional statutes and laws.

· Manage diary in accordance with Best Practices and complete tasks to ensure that cases move to the best financial outcome and timely resolution.

· Where litigation is filed, evaluate exposure and work with defense counsel to establish strong defenses, prepare litigation plan of action, set legal reserve and manage litigation over life of claim.

· Close all files as appropriate in a timely and complete manner.

· Maintain closing ratio as directed by management team.

· Oversee and coordinate medical treatment for injured employees and provide information to treating physicians regarding employees’ medical history, health issues, and job requirements; provide direction to assigned nurse case manager where applicable.

· Complete PARs (payment authorization request) when applicable.

· Comply with all excess and reinsurance reporting requirements; manage self-insured retention reporting.

· Communicate effectively, verbally and in writing with internal and external parties on a wide variety of claims and account-related issues.

Qualifications:

· High School diploma required;

· Associate’s or Bachelor’s degree preferred, or five or more years of equivalent work experience required in an insurance, medical/health or legal related industry;

· At least 2-3 years of experience handling New Jersey workers’ compensation claims required; more experience may be required depending upon complexity of claim pending.

· Completion of Workers’ Compensation training courses internally and/or externally in all significant areas affecting Workers’ Compensation claims handling and practices.

· Workers’ Compensation licenses, certifications, awards preferred.

Benefits:We’re committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. Benefits eligibility may differ depending on full-time or part-time status. Compensation depends on the applicable US geographic market. The expected base pay for this position ranges from $20.96 - $24.04 hourly, and will be based on a number of additional factors including skills, experience, and education.    The Company is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.    Don’t meet every single requirement? Studies have shown that women and underrepresented minorities are less likely to apply to jobs unless they meet every single qualification. We are dedicated to building a diverse, inclusive, and authentic workplace, so if you’re excited about this role but your past experience doesn’t align perfectly with every qualification in the job description, we encourage you to apply anyway. You may be just the right candidate for this or other roles.#LI-MC1#COV