PMA Companies is seeking Senior Claims Adjusters for opportunities to support new business growth and expansion in our Eastern Region. Opportunities exist in both our Insurance Company and TPA operations. This is an exciting opportunity to join an established company with incredible growth potential.
As a member of our claims team, utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position you will administer and resolve Workers Compensation claims in a timely manner in accordance with legal statues, policy provisions and company guidelines.
- Promptly investigate all assigned claims with minimal supervision, including those of a more complex nature.
- Determine coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable).
- Alert Supervisor and Special Investigations Unit to potentially suspect claims.
- Ensure timely denial or payment of benefits in accordance with jurisdictional requirements.
- Establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure.
- Negotiate claims settlements with client approval.
- Establish and implement appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition.
- Work collaboratively with PMA nurse professionals to develop and execute return to work strategies.
- Select and manage service vendors to achieve appropriate balance between allocated expense and loss outcome.
- Maintain a working knowledge of jurisdictional requirements and applicable case law for each state serviced.
- Demonstrate technical proficiency through timely, consistent execution of best claim practices.
- Communicate effectively, verbally and in writing, with internal and external parties on a wide variety of claims and account issues.
- Provide a high degree of customer service to clients, including but not limited to day to day interactions, claims reviews and stewardship meetings.
- Authorize treatment based on protocols established by statute and/or the PMA Managed Care department.
- Assist PMA clients by suggesting panel provider information in accordance with state statutes.
Demonstrate commitment to Company's Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.
- Claims Adjusters License required
- Bachelor's degree, or four or more years of equivalent work experience.
- At least 5 or more years experience handling lost time workers compensation claims for assigned state or region.
- Associate in Claims (AIC) Designation or similar professional designation desired.
- Familiarity with medical terminology.
- Strong organizational skills and ability to manage multiple tasks simultaneously.
- Demonstrated ability to work independently and with a team.
- Ability to analyze data and make sound decisions.
- Strong verbal and written communication skills.
- Computer literacy, including working knowledge of MS Office products including Word, Excel and PowerPoint. Knowledge of Claim Center a plus.
- Ability to travel for business purposes, less than 10%.