The Senior Workers’ Compensation Claims Adjuster is responsible for the investigation, evaluation, management, and resolution of complex New Jersey workers’ compensation claims.
Compensation
The base compensation range for this position is $95,000 - $100,000.
Responsibilities
Manage a caseload of complex and litigated New Jersey workers’ compensation claims from assignment through final resolution.
Conduct timely investigations addressing course and scope, accident details, causation, prior medical history, witnesses, employment status, wages, and compensability.
Make well-supported compensability decisions and clearly document acceptance, denial, and investigation rationale.
Calculate and administer temporary total disability (TTD) benefits and average weekly wage information in accordance with New Jersey requirements.
Coordinate appropriate medical treatment, including specialist referrals, diagnostics, surgery, rehabilitation, work restrictions, and return-to-work planning.
Requirements
5+ years of workers' compensation claims handling experience
Salary range (but not limited to):
174,500 - 213,300
Annual bonus target, based on the base salary, with a potential payout of up to double the target (subject to personal and company performance):
20%
Responsibilities
Manage your team’s operations by organizing, planning and monitoring the optimal use of human resources in accordance with the company’s strategic objectives and priorities.
Represent Actuarial function on company task forces / committees and act as a point of contact for other business units.
Manage and provide technical guidance to your staff responsible for conducting actuarial studies and activities (reserve analysis, financial forecast, regulatory reports, etc.).
Manage performance reviews, training and coaching of your team members in order to attain the company’s strategic objectives.
Requirements
University Degree in Actuarial Science or Mathematics
Senior Claim Representative / Claim Counsel responsible for evaluating complex healthcare and professional liability claims, providing coverage analysis, litigation strategy, and coordinating with carriers and external counsel.
Compensation
$110,000 - $140,000 / year
Responsibilities
Evaluate coverage issues specific to healthcare professional liability, miscellaneous and insurance professionals E&O, insurers’ extra-contractual liability, and D&O claims.
Analyze claims-made and occurrence triggers, retroactive dates, prior knowledge and prior acts issues, interrelated claims, notice and reporting requirements, multiple insureds, allocation between coverages, and other complex coverage questions.
Draft and issue coverage position letters, including reservations of rights and denial letters, ensuring clarity and compliance with legal and regulatory standards.
Evaluate and provide input on coverage forms and policy language as needed by carriers.
Review and interpret primary, excess, and package policies, endorsements, applications, and applicable law to determine coverage, exclusions, conditions, limits, retentions, allocation, and other obligations.
Requirements
Juris Doctor (JD)
Nice to have: experience across two or more of healthcare professional liability, long-term care, miscellaneous E&O, broker or insurance professionals E&O, third-party administrator liability, insurers’ extra-contractual liability, or D&O
