Worker's Compensation Claims Adjustor 3-4
Posted on: January 15, 2022
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 can be remote, some travel to the
Piscataway, NJ office may be expected for training/meetings up to
25%. Candidate must be located near or within the Piscataway, NJ
area. The Workers' Comp Lost Time Claims Adjuster independently
investigates, evaluates, and resolves assigned medical only and
lost time Workers' Compensation claims in a timely manner in
accordance with legal statutes, policy provisions and company
guidelines. Responsibilities: -
- Evaluate injured worker eligibility; communicate with attending
physician, nurse case manager, employer and injured worker.
- Work with both the injured worker and their physician to
medically manage the claim, from initial medical treatment to
reviewing and evaluating ongoing treatment and related
- Work directly with employers to facilitate a return to work,
either on a full-time or modified duty basis.
- Work directly with manager and assistant manager to make
compensability decisions, monitor injured worker's progress, and
pay lost time and medical benefits.
- 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
- 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
- Manage diary in accordance with Best Practices and complete
tasks to ensure that cases move to the best financial outcome and
- 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
- Close all files as appropriate in a timely and complete
- 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) and FOCUS reports
- 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
- Provide a high degree of customer service to clients, including
face to face interactions during claim reviews, meetings and
similar account-specific sessions.
- Perform other duties as required. 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
- At least 4 years of experience handling lost time 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 a plus
- Workers' Compensation licenses, certifications, awards
- Proficient with MS Excel and Word; computer experience with
related claims software; -
- Excellent verbal and written communication skills; proven
interpersonal skills capable of dealing with all levels of
- Ability to multi-task; superior organizational and decision
- Customer-focused orientation; excellent negotiation skills
- Expertise in Workers' Compensation and related claims handling
practices and ability to apply same; deep knowledge of client and
carrier claims procedures
- Significant understanding of self-insured retention, excess and
- Fluent in medical terminology and medical/injury treatments. -
*This role is Flex which allows most work to be performed at home.
Employees must be fully vaccinated if they choose to come onsite.
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. - The
Company is an equal opportunity employer, values the diversity of
our workforce and the knowledge of our people. The Company does not
discriminate against an applicant or employee on the basis of race,
color, religion, national origin, ancestry, sex/gender, age,
physical or mental disability, military or veteran status, genetic
information, sexual orientation, gender identity, gender
expression, marital status, or any other characteristic protected
by applicable federal, state or local law. - #LI-KA1
Keywords: Coventry, Trenton , Worker's Compensation Claims Adjustor 3-4, Other , Piscataway, New Jersey
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