14 claims jobs found in Trenton, NJ

The Functional Analysts (FA) Supervisor is responsible for providing supervision and leadership to FA staff. Provides guidance to FAs in the areas of business analysis and requirement life cycle management. Helps them to resolve conflict within their portfolio and across portfolios. Provides continuous feedback to staff on areas of improvement and growth. Encourages team members to keep them motivated and engaged. Help staff with any blockers for successful performance. Addresses staffing needs in support of assigned portfolio(s). This role requires leading other team members and coordinating work efforts, leading problem and solution scoping efforts, and effectively communicating requirements. Essential Duties and Responsibilities: Strategy Analysis:  Consistently support the alignment of business strategy with system implementations by guiding and leading the FA team. Business Analysis/Elicitation Skills:  Consistently support and guide FA team members to ensure that...

The overall responsibility of this position is to consistently execute on the Company’s mission, vision, and values, leading customer service approach, and claims business model to provide best outcomes on complex/high severity claims. The Complex Claims Specialist, Senior will be responsible for contacting all parties involved in the claim, gathering, and securing all necessary information to effectively evaluate the claim, and implement an action plan to manage the claim. The Complex Claims Specialist, Sr will work with and communicate to NJM policyholders, injured workers, medical providers, the NJM Medical Services Administration Department, Special Investigation Unit, WC Legal Staff, other departments within NJM, and vendors as needed. This is a senior level position in the Complex Claims track that will require minimal supervision and guidance to accomplish the goals and objectives of the role. Essential Duties and Responsibilities: Review, investigate, and analyze...

The Personal Lines Claims Specialist, Senior appropriately manages and resolves bodily injury claims across multiple states, and if necessary, through the litigation process.  This includes contacting insureds, claimants, attorneys, witnesses and other carriers, and investigating, negotiating, and settling claims based on company guidelines and applicable law, as well as securing and maintaining required licenses. This position could be filled at the Level II or Senior Level, based on skills and experience. Essential Duties and Responsibilities: Initiate appropriate action to conclude all clams in a manner consistent with existing law, licensure and company guidelines Conduct ongoing review independently and with supervisor of all assigned files focusing on adequacy of reserves and required investigation Communicate effectively with trial counsel and prepare required reports necessary for evaluation and conclusion of litigated claims Investigate, review, analyze, and...

The Subrogation Claims Rep II is responsible for analyzing and conducting investigation of all assigned files for recovery and resolution of subrogation claims utilizing effective negotiation skills of liability and damage disputes. Responsibilities: Receive and process subrogation claims, seeking recoveries from adverse parties and/or their insurance carriers. Thoroughly review, evaluate and investigate subrogation claims to obtain necessary information for prompt resolution. Negotiate subrogation claims and resolve liability and/or damage disputes for successful recoveries.  Efficiently credit recovery checks and issue deductible payments to our insured. Claims are settled and negotiated based on company guidelines and applicable state negligence laws. Professionally respond and communicate on all subrogation related issues. Provide excellent customer service to our policyholders. Comply with department procedures and metrics. Required Qualifications: Minimum...

Join NJM Insurance Group’s Medical Claim Services (MCS) team as a Business Process Operations Analyst, where you will play a key role in driving process improvement and support business continuity and technology initiatives. The primary purpose of this role is to provide consistent support to business users in both technology and non-technology operations, including incident management, production support, and departmental activities and assist in the seamless operationalization of new processes and technology solutions, ensuring smooth transitions and effective change management for business users. This position requires subject matter expertise (SME) in Personal Injury Protection (PIP), Workers’ Compensation, and/or General Claims. The ideal candidate will have a strong understanding of current business processes and the ability to identify, design, and implement effective improvements. Essential Duties and Responsibilities: Support Strategic Plan, Leadership, and...

The First Notice of Loss Associate serves as the first point of contact for policyholders, claimants or other parties reporting claims. They are responsible for addressing customer inquiries concerning the claim process and collecting essential details about the incident, to accurately and efficiently establish new Auto, Property and Commercial claims.   Tuesday to Saturday (8:15am-4:30pm). This includes a 5% shift differential. Essential Duties and Responsibilities: Receive initial reports of loss or damage from policyholders, claimants or other parties. Accurately process information into the system for assignment to an adjuster. Address customers’ questions and concerns related to the claims process and procedures and offer clear instructions on the next steps. Determine appropriate coverage and complete necessary follow-ups in a timely manner. Navigate systems with proficiency to access appropriate information to service callers. Perform additional duties...

There's never been a better time to join NJM! With a nationally ranked reputation for outstanding customer service and a history that spans more than a century, NJM is a leading provider of worker's compensation, automobile, and homeowners insurance in New Jersey. Our MCS (Medical Claims Services) Medical Bill Processing Department has an opening for a Bill Processor and is seeking a candidate who has excellent communication skills as well as strong organizational and time management skills. The Bill Processor (BP) is responsible and accountable for the timely audit and processing of medical bills.  Timely and accurate processing is vital to ensuring that medical bills meet all regulatory timeframes. Essential Duties and Responsibilities: Accurately audit and process standard medical bills for routine procedures within statutory timeframes, by following medical coding guidelines and department policies and procedures Verify correct payee and provider information and...

NJM Insurance Group, is a leading mid-sized U.S. property and casualty insurance company with 90 consecutive years of A+ financial strength ratings by AM BEST. Due to exceptional employee experience, NJM has been included on the latest Forbes List of Best Employers in New Jersey for the fourth year in a row. The NJM reputation for being a top provider of outstanding customer service was reaffirmed by the most recent J.D. Power Auto Insurance Claims Survey. Over the last five years, the Company has focused on a strategic plan that calls for it to become a regional property & casualty insurer and has transitioned away from its affinity-based membership model. To that end, the Company has added an independent agency model for new lines of middle and large commercial and has more than doubled its product offerings. NJM now offers its various products to businesses across New Jersey, Pennsylvania, New York, Maryland, Delaware, and Connecticut. Celebrating its 110-year...

Do you have a passion for customer service? Are you looking for a company that offers you more? Come talk to NJM Insurance Group, a 6 - time recipient of the Forbes Best Employers in New Jersey about joining our Contact Center! Join a best-in-class team that has been certified by J.D. Power for providing personal lines customers with an exceptional Auto Claims Experience - 7 years in a row ! Our Contact Center team enjoy: Salary begins at $51,120.55 with the potential to earn more if you are licensed with experience (Salary is commensurate with experience and credentials) Company paid training and professional state licensure. Potential annual bonus incentive worth up to 7.5% of your first year’s base salary Hybrid work schedule once training is completed An outstanding benefits package (outlined below), including a 401k with a dollar for dollar match up to 8% The Opportunity NJM is seeking talented, friendly customer service orientated...

New Jersey Manufacturers Insurance Company (NJM) was founded in 1913 by a group of manufacturers seeking to provide cost-effective, safety conscious and financially secure workers' compensation insurance for their workers. From inception the Company has operated as a mutual, with a focus on the needs of its policyholders. Today, NJM Insurance Group, is a leading mid-sized U.S. property and casualty insurance company with 90 consecutive years of A+ financial strength ratings by AM BEST. Due to exceptional employee experiences, NJM has been included on the latest Forbes List of Best Employers in New Jersey for the fourth year in a row. The NJM reputation for being a top provider of outstanding customer service was reaffirmed by the most recent J.D. Power Auto Insurance Claims Survey. Over the last five years, the Company has focused on a strategic plan that calls for it to become a regional property & casualty insurer and has transitioned away from its...

New Jersey Manufacturers Insurance Company (NJM) was founded in 1913 by a group of manufacturers seeking to provide cost-effective, safety conscious and financially secure workers' compensation insurance for their workers. From inception the Company has operated as a mutual, with a focus on the needs of its policyholders. Today, NJM Insurance Group, is a leading mid-sized U.S. property and casualty insurance company with 90 consecutive years of A+ financial strength ratings by AM BEST. Due to exceptional employee experience, NJM has been included on the latest Forbes List of Best Employers in New Jersey for the fourth year in a row. The NJM reputation for being a top provider of outstanding customer service was reaffirmed by the most recent J.D. Power Auto Insurance Claims Survey. Over the last five years, the Company has focused on a strategic plan that calls for it to become a regional property & casualty insurer and has transitioned away from its affinity-based...

Reporting directly to the Medical Management Supervisor, the Workers' Compensation (WC) Case Manager supports the WC Department by following the best practices associated with managing of the injured worker effectively and efficiently. The position requires the nurse to work and communicate with other members of the Medical Management team in addition to the WC Claims team, WC Claims Supervisors, and other team members. The WC Team Lead also interacts with the associated injured parties or their legal representatives, medical providers, and other departments within NJM, as needed. The official NJM job title is Medical Management Coordinator. Essential Duties and Responsibilities: Demonstrate knowledge, skills, and competency in the application of case management standards of practice. Develop and provide ongoing support of the rehabilitation plan through comprehensive assessment, planning, implementation, and overall evaluation of individual claimant needs.  Facilitate...

Our Commercial Lines department is seeking a Premium Auditor with strong organizational and time management skills. The field auditor will be responsible for performing audits of Commercial Lines policies in accordance with company, industry and government rules and regulations in order to establish appropriate classifications, exposures, and basis of premium for each insured in. This position will cover Middlesex, Somerset and Union County. Essential Duties and Responsibilities: Conducting Premium Audits on Commercial Lines policies, which can include multi-state and/or multi-line policies. Performing a thorough review of the policyholder’s records to identify the insured’s exposures to the coverage provided. Verifying employer classes, claimant information, tax identification numbers, and payroll for the audit period, as well as other appropriate information required to ensure a complete and thorough audit. Documenting and processing the audit to explain deviations...

Our West Trenton General Claims Legal Department is seeking a motivated, detail-oriented individual for a PIP Appeal and Litigation (PAL) Processor Processor role. Reporting to the designated supervisor and accountable for efficiently collecting and organizing pertinent information of appeal, litigation/arbitration process for adjusters and defense counsel. Essential Duties and Responsibilities: Receive, analyze, and process complaints/arbitration demands, create litigation matters, and assign to appropriate PAL adjuster for review. Assist PAL Adjusters and supervisors by accurately entering pertinent information into Claim Center, OnBase, and AgilePoint.  Provide support as needed to FNOL First Notice of Loss (FNOL) Dept in taking claims. Review the investigation file material, select appropriate information, and electronically send to defense firms. Provide support to PAL Adjusters with document requests and information needed for pertinent matters. Process monthly...