Remote/Hybrid Workers’ Comp Claims Specialist II

Claims Resolution Corporation Inc.; Egg Harbor Township (NJ); Hybrid; USD 65,000 - 95,000; Full time

Benefits offered by this job

PTO

Health insurance

Dental insurance

Vision insurance

401(k)

HRA & FSA

Life insurance

Disability insurance

Job summary

Claims Resolution Corporation, Inc. is seeking an experienced Workers’ Compensation Analyst II to manage a caseload of complex medical treatment claims, including lost time and litigation, in NJ and PA.

The role involves coordinating medical care, negotiating settlements, and collaborating with claimants, clients, attorneys, and medical professionals to reach timely, cost-effective outcomes. This mid-level position emphasizes attention to detail, strong communication, and ability to work with

Qualifications

• 4+ years of handling Medical Only/Workers’ Compensation claims.
• Investigate, evaluate, and resolve lost time claims in compliance with NJ and/or PA workers' compensation laws.
• Establish and maintain accurate financial reserves; adjust reserves as claim conditions evolve.
• Report to excess carriers in accordance with policy thresholds and contractual obligations.
• Coordinate with medical providers, nurse case managers, and legal counsel to ensure appropriate treatment and litigation strategy.
• Attend mediations, depositions, and hearings as required.
• Communicate effectively with injured workers, employers, attorneys, and internal stakeholders.
• Maintain detailed and timely documentation in claims management systems.
• Prepare comprehensive reports and updates for clients and internal leadership.

Responsibilities

• Manage a caseload of workers' compensation claims involving complex medical treatment and litigation.
• Investigate, evaluate, and resolve lost time claims in compliance with NJ and/or PA workers' compensation laws.
• Establish and maintain accurate financial reserves; adjust reserves as claim conditions evolve.
• Report to excess carriers in accordance with policy thresholds and contractual obligations.
• Coordinate with medical providers, nurse case managers, and legal counsel to ensure appropriate treatment and litigation strategy.
• Attend mediations, depositions, and hearings as required.
• Communicate effectively with injured workers, employers, attorneys, and internal stakeholders.
• Maintain detailed and timely documentation in claims management systems.
• Prepare comprehensive reports and updates for clients and internal leadership.

Skills

Medical claims handling

Communication skills

Attention to detail

Microsoft Office

Tools

Claims management software

Job description

Claims Resolution Corporation, Inc. is seeking an experienced Workers’ Compensation Analyst II to manage a caseload of complex medical treatment claims, including lost time and litigation, in NJ and PA.

The role involves coordinating medical care, negotiating settlements, and collaborating with claimants, clients, attorneys, and medical professionals to reach timely, cost-effective outcomes. This mid-level position emphasizes attention to detail, strong communication, and ability to work with