Workers' Compensation Analyst II

Workers’ Compensation Analyst II

We are growing! Claims Resolution Corporation, Inc., located in Egg Harbor Township, New Jersey, is a full-service, multi-line claims management provider, including Workers’ Compensation, General Liability, Auto Liability, Professional, and Property claims administration services. Our client-focused, ethical, and relationship-based team members are the heart of our vision to be the best third-party administrator (TPA). If you are eager to collaborate within a diverse team, embrace challenges, and continue to develop your skills, then Claims Resolution Corporation, Inc. may be the place for you. We offer a career-oriented environment that values your contributions and encourages you to grow.

Remote, hybrid, and in-person work options for candidates in NJ, PA, and DE.

Position Summary:
This mid-level position is responsible for managing a caseload of complex medical treatment claims involving lost time, multiple body part injuries, and litigation in New Jersey and /or Pennsylvania. The analyst Independently manages the investigation, evaluation, and resolution of workers’ compensation claims in compliance with legal statutes, policy terms, and client-specific instructions. The analyst coordinates medical care, negotiates settlements, and works closely with claimants, clients, attorneys, and medical professionals to achieve timely, cost-effective outcomes. This role also serves as a technical resource and advocate for client claim concerns. This position is ideally in-person or hybrid; however, a remote work option may be considered for candidates residing in NJ, PA, or DE.

Key Responsibilities:

• Manage a caseload of workers' compensation claims involving complex medical treatment and litigation.
• Investigate, evaluate, and resolve lost time claims in compliance with NJ and/or PA workers' compensation laws.
• Establish and maintain accurate financial reserves; adjust reserves as claim conditions evolve.
• Report to excess carriers in accordance with policy thresholds and contractual obligations.
• Coordinate with medical providers, nurse case managers, and legal counsel to ensure appropriate treatment and litigation strategy.
• Attend mediations, depositions, and hearings as required.
• Communicate effectively with injured workers, employers, attorneys, and internal stakeholders.
• Maintain detailed and timely documentation in claims management systems.
• Prepare comprehensive reports and updates for clients and internal leadership.

Qualifications:

• 4+ years of handling Medical Only/Workers’ Compensation claims.
• Investigate, evaluate, and resolve lost time claims in compliance with NJ and/or PA workers' compensation laws.
• Establish and maintain accurate financial reserves; adjust reserves as claim conditions evolve.
• Report to excess carriers in accordance with policy thresholds and contractual obligations.
• Coordinate with medical providers, nurse case managers, and legal counsel to ensure appropriate treatment and litigation strategy.
• Attend mediations, depositions, and hearings as required.
• Communicate effectively with injured workers, employers, attorneys, and internal stakeholders.
• Maintain detailed and timely documentation in claims management systems.
• Prepare comprehensive reports and updates for clients and internal leadership.
• Public entity experience strongly preferred.
• Strong attention to detail and investigative mindset.
• Excellent written, verbal, and interpersonal communication skills.
• Proficient in Microsoft Office, internet-based systems, and claims software.

Physical Requirements:

Prolonged periods of sitting and computer work.

Employee Benefits:

We offer a comprehensive benefits package, including:

• Paid time off
• Medical, dental, and vision insurance
• 401(k)
• HRA & FSA
• Group life, STD, and LTD insurance, and more!

Claims Resolution Corporation, Inc. is an Equal Opportunity Employer, providing employment opportunities to all qualified individuals regardless of race, creed, color, sex, sexual orientation, religion, national origin, age, disability, or any other basis prohibited by law.

This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.