Claims Director jobs in Atlantic City, NJ

The Enlyte Family of Businesses

Mitchell | Genex | Coventry

Enlyte is the parent brand of Mitchell, Genex and Coventry, an organization unlike any other in the Property & Casualty industry, bringing together three great businesses with a shared vision of using technology innovation, clinical services and network solutions to help our customers and the people they serve. Our suite of products and services enable our employees to help people recover from challenging life events, while providing opportunities for meaningful impact and career growth.

Investigates, adjusts and resolves assigned Workers' Compensation claims in a timely manner in accordance with legal statutes, policy provisions and company guidelines.

Perks: Full and comprehensive benefits programs starting on your first day, 24 days of paid vacation/holidays in your first year plus sick days, Employee Assistance and a Referral Program.

• Evaluate claimant eligibility; communicate with attending physician, employer and injured worker.
• Work with the claimant and their physician to medically manage the claim, from initial medical treatment to reviewing and evaluating ongoing medical treatment and related information.
• Work directly with employers to facilitate return to work, either on a full-time or modified duty basis.
• Confirm coverage and applicable insurance policy or coverage document and statutory requirements.
• Identify potential for third party recovery, including subrogation, Second Injury Fund or other fund involvement (when applicable) and excess or reinsurance reimbursement. Pursue the process of reimbursement and complete posting of recovery to the claim file, where appropriate.
• Identify potential for disability or pension credits or offsets.
• Assign field adjuster investigation on potentially suspect claims.
• Ensure timely denial or payment of benefits in accordance with jurisdictional requirements.
• Establish claim reserve levels by estimating the potential exposure of each assigned claim, establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure.
• Establish compensability status through case investigation and evaluation and application of jurisdictional statutes and laws.
• Where litigation is filed, evaluate exposure and work closely with defense counsel to establish strong defenses, prepare litigation plan of action, set legal reserve and manage litigation over life of claim.
• Manage diary in accordance with Best Practices and complete tasks to ensure that cases move to the best financial outcome and timely resolution.
• Close all files as appropriate in a timely and complete manner.
• Maintain closing ratio as directed by management team.
• Oversee and coordinate medical treatment for injured employees and provide information to treating physicians regarding employees' medical history, health issues, and job requirements; provide direction to assigned nurse case manager where applicable.
• Complete PARs (payment authorization request) when applicable.

Minimum education: High School Diploma or equivalent

Prefered skills and experience: Associate or bachelor's degree preferred, or four or more years of insurance, medical/health or legal related work experience. Completion of basic Workers' Compensation training courses, internally and/or externally

Required skills and experience 1-2 years of experience handling workers' compensation claims. MS Excel and Word; computer experience with related claims software; excellent verbal and written communication skills; ability to multi-task; good negotiation skills; superior organizational skills; customer-focused orientation; strong analytical skills;

PI238706257