Senior NJ WC Claims Examiner (Hybrid)

TEEMA Solutions Group; Philadelphia (Philadelphia County); Hybrid; USD 85,000 - 95,000; Full time

Benefits offered by this job

Hybrid schedule – 2 days in office

Job summary

TEEMA Solutions Group seeks an experienced Workers’ Compensation Claims Examiner III to join a national claims organization in a hybrid Philadelphia, PA setting. You will independently manage complex indemnity NJ claims from initial report through resolution.

The role requires 3–5+ years of NJ WC claims handling, handling 125–150 indemnity claims, and applying expanded reserve/settlement authority. Competitive salary and minimal supervision offered.

Qualifications

• 3–5+ years of Workers’ Compensation claims handling experience.
• Strong New Jersey Workers’ Compensation claims experience required.
• Experience handling complex indemnity claims independently.
• Strong knowledge of New Jersey Workers’ Compensation statutes and regulations.
• Experience with compensability decisions, investigations, medical management, reserves, litigation, and settlements.

Responsibilities

• Manage approximately 125–150 Workers’ Compensation indemnity claims.
• Handle complex New Jersey Workers’ Compensation claims from initial report through resolution.
• Investigate claims and make compensability determinations.
• Administer benefits in accordance with state regulations and company guidelines.
• Review medical records, treatment requests, work status, and claim documentation.
• Authorize and coordinate appropriate medical treatment.
• Review and manage medical billing issues.
• Establish and adjust reserves based on claim exposure.
• Exercise expanded reserve and settlement authority appropriate to the Examiner III level.
• Develop claim strategies to drive timely and appropriate resolution.
• Refer claims to defense counsel and provide ongoing direction regarding litigation strategy.
• Review legal recommendations and monitor litigation developments.
• Negotiate settlements and obtain additional authority when necessary.
• Maintain accurate documentation and a disciplined diary system.
• Communicate with clients regarding claim status, exposure, reserves, and resolution strategies.
• Identify injury trends and potential safety concerns.
• Coordinate with loss-control resources when appropriate.
• Maintain compliance with applicable Workers’ Compensation statutes and regulations.

Skills

New Jersey workers’ comp experience

Claims handling experience

Indemnity claims

Investigations & compensability

Tools

Microsoft Word

Excel

Job description

TEEMA Solutions Group seeks an experienced Workers’ Compensation Claims Examiner III to join a national claims organization in a hybrid Philadelphia, PA setting. You will independently manage complex indemnity NJ claims from initial report through resolution.

The role requires 3–5+ years of NJ WC claims handling, handling 125–150 indemnity claims, and applying expanded reserve/settlement authority. Competitive salary and minimal supervision offered.