Senior Claims Adjuster - Workers Compensation
- Employer
- PMA Companies
- Location
- Wallingford Connecticut
- Salary
- Not Specified
- Posted
- Aug 31, 2017
- Closes
- Nov 30, 2017
- Ref
- 1568#GIJ--PMA.1
- Category
- Claims
- Job Type
- Full Time
- Career Level
- Not Specified
PMA Companies is seeking Senior Claims Adjusters for opportunities to support new business growth and expansion in our Northeastern & New England Regions. 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.
Responsibilities:
- 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.
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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.