Claim Specialist - NJ and PA Jurisdictions

Job Overview: Claim Specialist II or III in NJ & PA Jurisdictions

The Claim Specialist investigates, evaluates, negotiates, and resolves lost time claims within settlement and reserving authority up to stated maximum. (Supervisor will determine actual individual authority up to the stated maximum). Conducts training classes (including research and position papers) for less experienced Claim Department Representatives. Based on experience and proven ability, an expanded and more difficult caseload will be expected, requiring a lesser degree of supervision.

Key Responsibilities

• Claims Management: Investigate, evaluate, negotiate and resolve medical-only and lost time claims within settlement and reserving authority up to stated maximum.
• Communication: Serve as a point of contact for insureds, injured workers, agents, brokers, attorneys, and other stakeholders to gather necessary information and provide timely updates.
• Benefit Delivery: Administer medical and indemnity benefits in compliance with NJ and PA state workers' compensation statutes and MEMIC's best practices.
• Quality Assurance: Maintain organized and high-quality claim files in accordance with company policies and procedures.
• Managed Care Coordination: Implement Managed Care strategies, coordinate rehabilitation plans, process medical bills, and monitor case progress.
• Legal & Regulatory Compliance: Interact with state and federal boards and commissions to ensure proper reserves and compliance with laws and regulations.
• Ongoing Learning: Stay updated on state laws and workers' compensation trends through MEMIC-provided training and external certifications like WCP or Claims Law (AEI).

Qualifications

• 3+ years workers' compensation lost time claim handling experience required.
• Strong attention to detail and excellent verbal and written communication skills.
• Proficiency in Microsoft Office Suite (Word and Excel) required and Imageright preferred.
• Self-motivated, flexible, and capable of managing time and priorities effectively in a fast-paced environment.
• Ability to collaborate and build relationships with cross-functional teams.
• Valid driver's license required.
• Must have required adjuster's licenses in applicable states. (NJ and PA)

Why Join MEMIC?

At MEMIC, we value our employees and offer an exceptional benefits package to support your well-being and professional development, including:

• Health & Wellness: Health, dental, and vision insurance, plus an annual wellness reimbursement.
• Financial Security: 401(k) retirement plan with up to 6% match, profit sharing, and life insurance.
• Paid Time Off: Five weeks of PTO and 11 paid holidays.
• Education & Career Growth: Student loan paydown assistance, tuition reimbursement, and professional development opportunities.
• Work-Life Balance: Paid volunteer day each year.

Join MEMIC Today!

Ready to make an impact in workers' compensation insurance? As a Claim Specialist, you'll play a critical role in ensuring injured workers receive the support they need while helping businesses thrive.

MEMIC is committed to fostering a diverse and inclusive workplace. We are an equal opportunity employer, encouraging applicants of all backgrounds and identities to apply.

Apply today and launch your career with MEMIC, where safety and compassion are at the heart of everything we do.

MEMIC is committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religious creed, national origin, ancestry, age, disability, genetics, gender identity, veteran's status, sexual orientation, or any other characteristic protected by law. Additionally, we are committed to providing an inclusive and accessible recruitment experience for all candidates. If you need a reasonable accommodation during the interview process, please contact us at hr@memic.com.

To ensure an equitable and authentic interview process, candidates should not use AI or chatbot tools during the live interview or phone screen. We welcome any preparation you choose to do beforehand, but all responses shared during the interview must be your own.

Note: MEMIC does not offer Stem-OPT EAD Extension for this role.

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Targeted Salary: $75,000-$95,000 depending on experience