Sr. Account Claims Representative
PMA, an Old Republic Company, has a unique, fully remote opportunity for an experienced Multi-state Workers Compensation Claims Adjuster on our exclusive full-time permanent Regional Technical Support Team! Bring your expertise to our group of highly regarded claims professionals who play a critical role in our organization's success. Enjoy work/life balance filling in for our adjusters who are on vacation or leave to keep their desks moving forward and our clients satisfied. If you like variety, are solution oriented and team focused but no longer want the responsibility of handling claim reviews and an ongoing pending this is the role for you!
- 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 face to face interactions during claims reviews, stewardship meetings and similar account-specific sessions
- Authorize treatment based on the practiced protocols established by statute or the PMA Managed Care department
- Assist PMA clients by suggesting panel provider information in accordance with applicable 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.
- Bachelor's degree, or four or more years of equivalent work experience required in an insurance related industry required
- At least 3-5 years' experience handling lost time workers compensation claims required; past experience with multiple jurisdictions is required
- Associate in Claims (AIC) Designation or similar professional designation desired.
- Active license required or ability to obtain license within 90 days of employment in mandated states.
- Familiarity with medical terminology and/or Workers' Compensation
- Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously
- Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details
- Strong verbal, written communication skills and customer service skills
- Computer literacy, including working knowledge of MS Office Product Suite, i.e. Word, Excel, PowerPoint.
- Ability to travel for business purposes, approximately less than 10%.