NJM Insurance Group · 1 month ago
Workers Compensation Claims Specialist, Sr
Pittsburgh, PA
Full-time
Hybrid
Senior Level
$79K/yr - $92K/yr
5+ years expNJM Insurance Group is seeking an experienced Senior Workers Compensation Claims Specialist to provide on-site service to policyholders and agents in Western or Central PA. The role focuses on delivering guidance and empathy to customers while managing claims efficiently and effectively, ensuring compliance with best practices and company guidelines.
InsuranceManufacturingTransportation
Responsibilities
Ensure quality management of claims in accordance with claims best practices and company guidelines, and timely, accurate documentation of claim activity
Provide a high level of customer service that promotes injured worker advocacy-based principles to improve outcomes for all parties
Determine compensability and coverage issues by gathering medical and factual evidence
Administer the delivery of timely, appropriate, and accurate benefits
Evaluate the claim for potential fraud indicators and escalate the claim to SIU, as appropriate
Recognize and investigate subrogation opportunity and refer to NJM subrogation staff for recovery of third-party funds
Initiate and provide excellent communication with all stakeholders (injured workers, medical providers, attorneys, policyholders, agents, etc.) professionally and proactively with a customer-centric approach
Apply critical thinking skills to evaluate and mitigate exposures, and establish and implement a proactive strategic plan of action
Assign and refer claim petitions to Counsel, and work to resolve the claim within given authority
Build rapport with policyholders and agents, conduct on-site investigations when necessary, and educate policyholders and agents on NJM procedures, policies, and claim practices
Prepare and attend Claim Reviews at policyholder or agent locations in Western and/or Central PA or virtually for further locations
Serve as a liaison between policyholders/agents and various departments in NJM
Represent WC Claim in on-site capabilities meetings to onboard new policyholders in Western and/or Central PA
Participate in training programs to keep current on relevant issues/topics
Recommend process improvement where applicable to best improve the department efficiency, work product, and service commitment to interested parties
Demonstrate a commitment to NJM’s Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards, and laws applicable to job responsibilities in the performance of work
Qualification
Required
5+ years' experience as a Workers' Comp Claim Representative, or comparable knowledge and experience with various aspects of claims handling and/or process including advanced knowledge of medical terminology and WC regulations for PA, MD and/or DE claims
Knowledge of and/or experience working with liens and Medicare Set-Asides to secure full and final settlements
Customer service oriented with strong written and oral communication skills
Strong interpersonal skills with ability to work both in a team and independently
Demonstrated organizational skills, and use of sound decision-making capabilities
Working knowledge utilizing an automated claim processing system and Microsoft Office tools including Word and Outlook
Licensed in DE and/or CT to adjust WC claims or have the ability to obtain these licenses within 90 days
Ability to travel for business purposes, approximately 2 – 3 days a week meeting with policyholders and/or agents
Preferred
Associate or bachelor's degree
AIC/CPCU or other applicable insurance designations
Experience using Guidewire Claim Center, OnBase and additional Microsoft Office tools including Teams, Excel and PowerPoint
Knowledge and experience in claims handling for other commercial line products in various states including PA, MD and/or DE
Benefits
401(k) with employer match up to 8% and additional service-based contributions
Health, Dental, and Vision insurance
Life and Disability coverage
Generous PTO
Paid Sick Leave
Paid parental leave
State-mandated leave
Discretionary bonuses
Company
NJM Insurance Group
NJM (New Jersey Manufacturers) is an auto, homeowners, renters, commercial auto, umbrella and workers' compensation insurance providers.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Chris Malone
SVP, CFO & Treasurer
Carol Voorhees
Senior Vice President & Chief Information Officer
Recent News
2025-08-21
Company data provided by crunchbase