Workers Compensation Claims Examiner – DE License Preferred

Jobtailor; New Jersey; On-site; USD 65,000 - 90,000; Full time

Job summary

Jobtailor is seeking an experienced claims professional to analyze Lost-Time claims for our clients in New Jersey. You will assess benefits due, adjudicate within service expectations, and gather information to determine exposure and settlement decisions.

The role requires negotiation within authority, clear communication with claimants and clients, and adherence to industry best practices. A relevant certification and knowledge of NJ licensing are a plus.

Qualifications

• High School Diploma or GED required.
• Bachelor's degree from an accredited college or university preferred.
• Professional certification as applicable to line of business preferred.
• 2-3 years of claims management experience or equivalent combination of education and experience required.
• Jurisdiction Knowledge: NJ PA VA DE Licensing: DE preferred, not required.

Responsibilities

• To analyze Lost-Time claims on behalf of our valued clients to determine benefits due.
• Ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.

Skills

Claims management experience

Negotiation skills

Jurisdiction knowledge

Action plan development

Client communication

Education

High School Diploma or GED

Bachelor's degree preferred

Professional certification

Job description

• To analyze Lost-Time claims on behalf of our valued clients to determine benefits due.
• Ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.

Requirements

• High School Diploma or GED required.
• Bachelor's degree from an accredited college or university preferred.
• Professional certification as applicable to line of business preferred.
• 2-3 years of claims management experience or equivalent combination of education and experience required.
• Jurisdiction Knowledge: NJ PA VA DE Licensing: DE preferred, not required.

Core Competencies

Demonstrates expertise in claims management, including analyzing Lost-Time claims, negotiating settlements, and ensuring compliance with industry best practices. Strong communication skills are essential for effectively interacting with claimants and clients.

Highest-signal resume keywords

• Claims Management Experience
• Negotiation Skills
• Jurisdiction Knowledge
• Action Plan Development
• Client Communication

ATS Optimization Keywords

Hard Skills

• Claims Analysis
• Claims Processing
• Settlement Negotiation
• Adjudication
• Information Gathering

Soft Skills

• Communication
• Problem-Solving
• Attention to Detail

Certifications & Qualifications

• Professional Certification

Industry Keywords

• Lost-Time Claims
• Service Expectations
• Best Practices
• Client Service Requirements
• Licensing