Senior Employee Benefits Representative (workers comp. & disability claims)

RESPONSIBILITIES:

1. Reviews applications for temporary disability and/or workers' compensation benefits to ensure that required information is submitted and the appropriate medical documentation is received. Advises employee of what is expected to start/continue benefits.
2. Reviews medical documentation for accuracy, compliance and duration of absence based on medical diagnosis. Communicates verbally and in writing with physician's office regarding questions and/or concerns in relation to the medical diagnosis.
3. Sets, maintains and updates case reserves.
4. Reviews Plan of Action, applies knowledge of case law and medical treatments in order to determine monetary value of a disability and/or workers' compensation case.
5. Remains in contact with employees as required during authorized absence, and ensures compliance with medical recommendations. Authorizes payments based on compliance.
6. Remains in contact with employee's assigned work location and Medical Services Department in order to assist employee's supervisor in maintaining manpower.
7. Discusses Plan of Action for benefit determination in conjunction with contracts, policies and past practices. Attempts to resolve contractual disagreements prior to a grievance being filed.
8. Assists in preparing litigated claims for pre-trial conferences. Attends pre-trial conferences in the attempt to resolve the claim before trial. Communicates company position regarding settlement proposals verbally and in writing.
9. Reviews first report of injury, and advises employee of what is expected to start/continue benefits. Conducts initial investigation when necessary.
10. Determines workers' compensation benefit entitlement, rate and effective date of payment consistent with Statutes and contracts.

SKILLS REQUIRED:

High School diploma, or equivalent, and four (4) years experience in workers' compensation and disability claims or medical environment. Must be able to communicate verbally and in writing with judges, attorneys, doctors and employees in a clear concise manner. Must be able to apply concepts (contracts/statutes) to day-to-day situations developing company position on each claim. Familiarity with automated claims management system, investigative skills and knowledge of medical terminology desirable. MS Office Word / Excel software application skills knowledge is required.

PLEASE INCLUDE SALARY REQUIREMENTS.

ONLY CANDIDATES UNDER CONSIDERATION WILL BE CONTACTED.

NJ TRANSIT is an Equal Opportunity Employer.