Abrar Admin

PMA Companies

<div>As a member of our Claims team, utilize your knowledge of Workers Compensation Claims 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 highest risk management expectations claims in a timely manner in accordance with legal statues, policy provisions, and company guidelines.

Responsibilities:
<ul>
<li>Promptly investigates all assigned claims with minimal supervision, including those of a more complex nature</li>
<li>Determines coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable)</li>
<li>Alerts Supervisor and Special Investigations Unit to potentially suspect claims</li>
<li>Ensures timely denial or payment of benefits in accordance with jurisdictional requirements</li>
<li>Within granted authority, establishes appropriate reserves with documented rationale, maintains and adjusts reserves over the life of the claim to reflect changes in exposure</li>
<li>Negotiates claims settlements within granted authority</li>
<li>Establishes and implements appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition</li>
<li>Works collaboratively with PMA nurse professionals to develop and execute return to work strategies</li>
<li>Selects and manages service vendors to achieve appropriate balance between allocated expense and loss outcome</li>
<li>Maintains a working knowledge of New York jurisdictional requirements and applicable case law for each state serviced</li>
<li>Demonstrates technical proficiency through timely, consistent execution of best claim practices</li>
<li>Communicates effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues</li>
<li>Provides a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account-specific sessions</li>
<li>Authorizes treatment based on the practiced protocols established by statute or the PMA Managed Care department</li>
<li>Assists PMA clients by suggesting panel provider information in accordance with applicable state statutes.</li>
<li>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.</li>
</ul>
#LI-Remote
Requirements:
<ul><li>Bachelor's degree and/or four or more years of equivalent work experience required in an insurance related industry required</li>
<li>CA jurisdiction experience required; AX experience is a plus</li>
<li>Associate in Claims (AIC) Designation or similar professional designation desired</li>
<li>License required or ability to obtain license within 90 days of employment in mandated states</li>
<li>Familiarity with medical terminology and/or Workers' Compensation
</li><li>Working knowledge of Workers Compensation regulations, preferably jurisdiction-specific</li>
<li>Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously</li>
<li>Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details</li>
<li>Strong verbal, written communication skills and customer service skills gained through previous work experience</li>
<li>Computer literacy, including working knowledge of MS Office Product Suite, i.e. Word, Excel, PowerPoint</li>
<li>Ability to travel for business purposes, approximately less than 10%.</li></ul></div>

Claims Specialist

Join PMA Companies and explore 1   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

PMA Companies

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Claims Specialist