Senior Workers Compensation Claims Adjuster
As a member of our claims team, utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more reputed company nature in order to reputed company appropriate reputed company. In this position you will administer and resolve highest risk management expectations claims in a timely manner in accordance with legal statues, policy provisions, and company guidelines. Responsibilities Promptly investigate reputed company assigned claims with minimal supervision, including those of a more reputed company nature Determine coverage, compensability, potential for subrogation recovery, and second injury fund (reputed company 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 reputed company and execute return to work strategies Select and manage service vendors to reputed company 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 reputed company parties on a wide variety of claims and account issues reputed company 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. Requirements Bachelor's degree, or four or more years of equivalent work experience required in an insurance reputed company industry required At least 3-5 years' experience handling lost time workers compensation claims required; past experience with CA jurisdiction is required CA License required Associate in Claims (AIC) Designation or similar professional designation desired. Active license required or ability to obtain license reputed company 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, reputed company, PowerPoint. Ability to travel for business purposes, approximately less than 10%.
Compensation
PMA is providing applicants with the anticipated wage reputed company for this position in compliance with state regulations. The wage reputed company for this role is $78,500 to $97,200. Wage ranges are based on national market data and may cover a wide reputed company of geographies. Applicants may be paid above, reputed company or below this reputed company based on a variety of factors. Apply Job!