Job Description
Summary:
The Senior Disability Claims Administrator reviews applications for temporary disability benefits claims to ensure that required information is submitted and the appropriate medical documentation is received. Advises employee of what is expected to start/continue TDB benefits.
PRINCIPAL ACCOUNTABILITIES:
Reviews applications for temporary disability benefits (TBD) claims to ensure that required information is submitted and the appropriate medical documentation is received. Advises employee of what is expected to start/continue TDB benefits.
Reviews medical documentation for accuracy, compliance and duration of absence based on medical diagnosis for TDB claims. Communicates verbally and in writing with physician's office regarding questions, concerns in relation to the medical diagnosis, and duration of absence for TDB claims.
Sets, maintains and updates TDB claim reserves.
Applies knowledge of collective bargaining agreements, medical diagnosis (not treatment) and case law in order to determine monetary value of a TDB case for reserve purposes.
Authorizes TDB claim payments in compliance with employee application, state law, collective bargaining agreement, medical diagnosis and duration of absence.
Remains in contact with employees as required during authorized absence and ensures compliance with medical recommendations on TDB claims.
Remains in contact with employee's assigned work location and Medical Services Department in order to assist employee's supervisor in maintaining manpower as it relates to TDB claims.
Attempts to resolve contractual disagreements prior to a grievance being filed regarding TDB benefit determination in conjunction with contracts, policies and past practices.
Workers' Compensation Accountability: The rep receives the first report of WC injury from their manager; verifies with the work location to ascertain if the employee is losing time; if no lost time the file is closed; if lost time they will need to process a payment for up to the first seven days of lost time provided authorization if received from Liberty Mutual.
In coordination Liberty Mutual, an external contracted vendor, determines Workers' Compensation (WC) supplemental entitlement rate and effective dates of payment consistent with statutes and collective bargaining agreements, for the first seven days. Prepare a holiday list of employees who are on WC for designated agreement/union holiday entitlement consistent with collective bargaining agreements.
Processes the salary continuation for police and non-agreement employees collecting WC in accordance to the collective bargaining agreement (police) and the NJ TRANSIT's corporate-wide policy (non-agreement); this is the differential between the TTD (temporary total disability) benefit that Liberty Mutual pays and the employee's full weekly salary.
Additional Qualifications/Responsibilities
KNOWLEDGE & SKILLS REQUIRED:
High School diploma, or equivalent.
Four (4) years' experience in disability claims, medical environment or other claims experience.
Must be able to communicate verbally and in writing with doctors and employees in a clear concise manner.
Must be able to apply state disability law to day-to-day situations and communicate the company position on each claim.
Familiarity with automated claims management system, investigative skills, and knowledge of medical terminology desirable.
At NJ Transit, you will enjoy a competitive salary and excellent benefits package:
Comprehensive Family Health Insurance - Medical, Prescription, Dental, Vision
Flexible Spending Account
Life Insurance
Paid Leave
Tuition Assistance
Pre-Tax Commuter Benefits Plan
Retirement Plans
401(a) - Retirement plan with a 6% employer contribution
401(k) - Retirement saving plan with up to an 3% company match
457(b) - Deferred Savings Plan