Synectics Inc. · 1 week ago
Claims Adjuster - Workers Compensation
Jersey City, NJ
Contract
Onsite
Senior Level
5+ years expSynectics Inc. is a company specializing in workers compensation claims management. They are seeking a Claims Adjuster to analyze and manage mid- and higher-level claims, ensuring compliance with industry standards and facilitating settlements.
ConsultingInformation TechnologyRecruitingStaffing Agency
Responsibilities
To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements
Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency
Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments
Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract
Manages subrogation of claims and negotiates settlements
Communicates claim action with claimant and client
Ensures claim files are properly documented and claims coding is correct
May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review
Maintains professional client relationships
Performs other duties as assigned
Supports the organization's quality program(s)
Lost Time Claim Management
End-to-end handling of indemnity claims, including initial investigation, compensability determination, and ongoing management
Reserving claims for ultimate exposure
Handling caseload of diaries, correspondence (including email and faxed documentation.)
Jurisdictional Knowledge
In-depth understanding of PA and NJ workers' compensation statutes, regulations, and case law
Familiarity with state-specific forms (e.g., LIBC forms for PA, WC forms for NJ)
EDI filing and clearing of errors
Wage Loss & Benefit Calculation
Accurate calculation of Average Weekly Wage (AWW) and Temporary Total Disability (TTD) benefits
Application of PA's 7-day waiting period and NJ's 7-day retroactive rules
Medical Management
Coordination of treatment plans, utilization review, and compliance with state medical fee schedules
Familiarity with NJ's authorized provider rules and PA's panel provider requirements
Litigation Handling
Managing claims in litigation, including working with defense counsel, attending hearings, and preparing testimony
Understanding of PA's Supersedeas process and NJ's informal/formal hearing procedures
Return-to-Work Coordination
Developing modified duty programs and collaborating with employers to facilitate early return-to-work
Communication & Documentation
Stakeholder Communication
Regular interaction with injured workers, employers, medical providers, and attorneys
Clear and timely documentation of all claim activities
Superior customer service and phone etiquette
Negotiation & Settlement
Experience negotiating lump-sum settlements and Section 32 agreements (NJ) or Compromise & Release (PA)
Drafting settlement evaluations and experience working with Medicare requirements
Qualification
Required
5 years' experience directly managing lost time claims in both NJ and PA
In-depth understanding of PA and NJ workers' compensation statutes, regulations, and case law
Familiarity with state-specific forms (e.g., LIBC forms for PA, WC forms for NJ)
Accurate calculation of Average Weekly Wage (AWW) and Temporary Total Disability (TTD) benefits
Coordination of treatment plans, utilization review, and compliance with state medical fee schedules
Experience negotiating lump-sum settlements and Section 32 agreements (NJ) or Compromise & Release (PA)
Clear and timely documentation of all claim activities
Superior customer service and phone etiquette
Managing claims in litigation, including working with defense counsel, attending hearings, and preparing testimony
Developing modified duty programs and collaborating with employers to facilitate early return-to-work
Preferred
Licenses are preferred, but not required
Benefits
Healthcare Insurance
Dental Insurance
Vision Insurance
401(k) Plan
Technical Certification Bonus
Company
Synectics Inc.
Synectics Inc. is a premier national staffing firm founded in 1984, headquartered in Chicago, Illinois.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Melissa Lounds
Executive Vice President, Strategic Partnerships
Recent News
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2025-12-19
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