Senior Claims Representative

NEW JERSEY SCHOOLS INSURANCE GROUP

JOB DESCRIPTIONTitle: Senior Claims Representative (workers' compensation)Department: ClaimsReports to: Claims SupervisorFLSAClassification: Exempt

Summary:Under the supervision of a Claims Supervisor, a Senior Claims Representative evaluates and manages assigned indemnity and medical only workers' compensation claims in accordance with Claims Department procedures. This includes developing a measure of loss for each assigned claim, resolving claims within the limits of authority where possible and obtaining management authority to resolve claims when necessary. A Senior Claims Representative operates with additional authority compared to a Claims Representative, and with more autonomy.

Functions:a. Initiates contact with individuals involved in claims and acquires information concerning the loss;b. Assembles and arranges factual information in a manner adequate to justify disposition subject to management authority;c. Develops a measure of damage for each loss;d. Consults with medical staff and legal counsel as necessary;e. Evaluates exposure and determines the action necessary to dispose of loss within authority level where possible;f. Initiates with Management authority the actions necessary to dispose of loss;g. Assembles, maintains, and prepares records;h. Reviews medical expense bills for appropriateness and payment;i. Provides customer service to internal and external clients relating to their claims; and,j. Approves benefit payments as well as payment of medical and legal expenses.

Qualifications:a. Bachelor's degree in Business Administration, Finance or Accounting or equivalent work experience required;b. Minimum of three years' experience in adjusting workers' compensation indemnity claims in the State of New Jersey required, experience adjusting workers' compensation for an intergovernmental risk pool is preferred;c. Associate in Risk Management, Certified Risk Manager, or Associate in General Insurance designation preferred;d. Ability to work in an office environment with moderate noise level, ability able to work flexible hours, including evenings and weekends, andthe ability to travel to other offices and client, carrier, and work sites as required; and,e. Residency in the State of New Jersey in accordance with the New JerseyFirst Act, N.J.S.A. 52:14-7, et seq., unless otherwise exempted.