Claims Examiner

About NJHA: The New Jersey Hospital Association is a not-for-profit trade organization committed to delivering support and services to the state’s hospitals, health systems and other healthcare providers. We share a collective goal of providing quality, affordable and accessible healthcare to the people of the Garden State.

Objective: Reviews simple to complex unemployment insurance claims with input from senior PCM staff. In disputed claims, conducts investigation with input from senior staff, determines if appeal is warranted and follows through with appeals process.

Essential Job Functions:

As a Claims Examiner, you will play a vital role in reviewing, investigating, and managing unemployment insurance (UI) claims. Working closely with senior staff, you will ensure compliance with NJ Unemployment Regulations, assess claim validity, and oversee the appeals process when necessary.

What You’ll Do:

• Investigate and evaluate UI claims to ensure compliance with NJ Unemployment Regulations
• Review separation documentation and maintain accurate electronic records, monitoring claims progress to ensure responses are submitted within prescribed deadlines
• Provide fact-finding details and documentation for State DOL to determinate of eligibility for benefits
• Communicate with employers and state officials to address claims issues
• Analyze monetary and non-monetary determinations for accuracy.
• Advise employers on appeal decisions and manage the appeals process in collaboration with senior staff.
• Maintain claims records and initiate protests on erroneous charges.
• Assist clients with penalty reviews, cancellations, and abatements.
• Participate in team meetings and project activities remotely and in-person.
• Abide by the terms and conditions of the Confidentiality & Non-Disclosure Agreement

Non-Essential Job Functions:

• Testifies at hearings when necessary to establish the timeliness of an appeal.
• Problem solving capabilities
• Attention to detail, time management and comfortable multitasking.

Qualifications: 

• High school diploma or equivalent
• Strong verbal and written communication skills
• Excellent problem-solving and critical-thinking abilities
• Confidence in decision-making and ability to work independently
• Proficiency in computer applications, including spreadsheet software
• Strong attention to detail, time management, and multitasking skills
• Ability to work with confidential information per company policies

Base Salary Range:  $40,000 - $50,000

NJHA offers benefits and other compensation programs such as medical, dental and vision insurance, flexible spending accounts, salary deferral plan, cash balance plan, paid vacation, holidays and wellness days, paid sick days, short/long term disability, tuition reimbursement, employee assistance program, membership in a credit union, life insurance, employee-discount programs, and use of an on-site fitness facility. 

NJHA is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, amnesty, status as a veteran, or any other category protected by federal, state, and local laws.