Senior Lost Time Claims Adjuster

1 month ago

Charlotte, United States PMA Companies Full time

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 highest risk management expectations 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 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 North Carolina jurisdiction 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%.

#J-18808-Ljbffr

  • Claims Adjuster

    6 days ago

    Charlotte, United States Sedgwick Full time

    **The 'Apply with SEEK' option will be utilized for International applicants, mainly Australia. If this does not apply to you please use the 'Apply' option.** Claims Adjuster - LiabilityIF YOU CARE, THERES A PLACE FOR YOU HERE For a career path that is both challenging and rewarding, join Sedgwicks talented team of 27,000 colleagues around the globe....

  • Claims Adjuster

    1 month ago

    Charlotte, United States Sedgwick Full time

    **Claims Adjuster - Workers Compensation** **Claims Adjuster - Workers Compensation** **The 'Apply with SEEK' option will be utilized for International applicants, mainly Australia. If this does not apply to you please use the 'Apply' option.** Claims Adjuster - Workers CompensationIF YOU CARE, THERES A PLACE FOR YOU HERE For a career path that is both...

  • Claims Adjuster

    3 weeks ago

    Charlotte, United States Sedgwick Full time

    **Claims Adjuster - Workers Compensation** **Claims Adjuster - Workers Compensation** **The 'Apply with SEEK' option will be utilized for International applicants, mainly Australia. If this does not apply to you please use the 'Apply' option.** Claims Adjuster - Workers CompensationIF YOU CARE, THERES A PLACE FOR YOU HERE For a career path that is both...

  • Claims Adjuster Workers Compensation

    4 weeks ago

    Charlotte, United States Gallagherbassett Full time

    ** Claims Adjuster Workers Compensation** **** New Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond...

  • Claims Adjuster Workers Compensation

    3 weeks ago

    Charlotte, United States Gallagherbassett Full time

    ** Claims Adjuster Workers Compensation** **** New Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond...

  • Mechanical Claims Adjuster

    2 weeks ago

    Charlotte, United States Hendrick Autoguard Inc. Full time

    Job DescriptionJob DescriptionResponsibilities:• Analyze, review, and interpret policies to assess coverage and liability.· Verify repair information to determine if coverage is within the guidelines of the service contract.• Establish and maintain proper loss and expense reserves on their claims.• Determine what investigation is necessary on more...

  • Claims Representative-Senior

    4 weeks ago

    Charlotte, United States City of Charlotte Full time

    Introduction An advanced claims adjusting position involving technical work in the field of management of public liability claims presented against the City of Charlotte, Mecklenburg County, and the Charlotte-Mecklenburg Board of Education. Claims management involves investigation, evaluation, negotiation, and adjustment of claims for alleged damages...

  • Lost and Found Coordinator

    5 days ago

    Charlotte, United States City of Charlotte Full time

    Overview The City of Charlotte is the largest municipality in North Carolina and the 15th largest city in the United States, with a total population of more than 897,000 citizens. A major commerce center, Charlotte hosts several of the nation’s largest banks and technology companies. Also known as the Queen City, Charlotte is home to the Carolina...

  • Claim Examiner

    3 weeks ago

    Charlotte, United States Sedgwick Claims Management Services Full time

    Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for...

  • Flood Field Adjuster

    4 weeks ago

    Charlotte, United States Alacrity Solutions Full time

    Job DescriptionJob DescriptionAlacrity SolutionsIndependent ContractorFlood Field AdjusterAbout Alacrity SolutionsAlacrity Solutions is a full end-to-end provider delivering streamlined insurance claims, repair, and recovery solutions. As one of the largest independent providers of insurance claims services in North America, we provide property, auto, heavy...

  • Flood Field Adjuster

    3 days ago

    Charlotte, United States Alacrity Solutions Full time

    Job DescriptionJob DescriptionAlacrity SolutionsIndependent ContractorFlood Field AdjusterAbout Alacrity SolutionsAlacrity Solutions is a full end-to-end provider delivering streamlined insurance claims, repair, and recovery solutions. As one of the largest independent providers of insurance claims services in North America, we provide property, auto, heavy...

  • Flood Field Adjuster

    3 weeks ago

    Charlotte, United States Alacrity Solutions Full time

    Job DescriptionJob DescriptionAlacrity SolutionsIndependent ContractorFlood Field AdjusterAbout Alacrity SolutionsAlacrity Solutions is a full end-to-end provider delivering streamlined insurance claims, repair, and recovery solutions. As one of the largest independent providers of insurance claims services in North America, we provide property, auto, heavy...

  • P&C TPA Oversight Claims Specialist

    2 weeks ago

    Charlotte, United States KING'S INSURANCE STAFFING LLC Full time

    Our client, a National Insurance Carrier, is seeking to add a P&C Oversight Claims Specialist to North Carolina operations. This person would be responsible for overseeing Commercial/Personal Auto, General Liability, Property, and Bodily Injury claims being handled by TPA's. This includes reviewing files, performing claim audits, provide action plans, and...

  • NA Claims Manager

    2 days ago

    Charlotte, United States Ab Electrolux Full time

    SUMMARY Electrolux North America, Inc. is the holding company for the North American operations of AB Electrolux, a global leader in the manufacture of appliances. Our products include refrigerators, freezers, dishwashers, ranges, washing machines, dryers and vacuum cleaners under familiar band names including Frigidaire, Tappan, and Electrolux. Electrolux...

  • NA Claims Manager

    2 days ago

    Charlotte, United States Electrolux Full time

    Finance Permanent Job Description SUMMARY Electrolux North America, Inc. is the holding company for the North American operations of AB Electrolux, a global leader in the manufacture of appliances. Our products include refrigerators, freezers, dishwashers, ranges, washing machines, dryers and vacuum cleaners under familiar band names including Frigidaire,...

  • Claims Examiner

    4 weeks ago

    Charlotte, United States Sedgwick Full time

    Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your...

  • Bodily Injury Claims Specialist

    4 weeks ago

    Charlotte, United States Auto-Owners Insurance Full time

    A career at Auto-Owners is challenging and rewarding. Our group of caring associates create financial security by helping individuals and businesses make a new start when a loss occurs. Job Description Job Description We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility...

  • Bodily Injury Claims Specialist

    3 weeks ago

    Charlotte, United States Auto-Owners Insurance Full time

    A career at Auto-Owners is challenging and rewarding. Our group of caring associates create financial security by helping individuals and businesses make a new start when a loss occurs. Job Description Job Description We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility...

  • Claims Specialist

    4 weeks ago

    Charlotte, United States Project Resources Group Full time

    Description Project Resources Group (PRG) immediately needs several Claims Specialists to join our growing Outside Plant Damage Recovery team in Charlotte, NC. The ideal candidates will be initiative-taking go-getters, have strong organizational skills, be exceptional communicators, have an analytical and bold personality, and thrive in a commission...

  • Claims Specialist

    7 days ago

    Charlotte, United States Project Resources Group Full time

    Description Project Resources Group (PRG) immediately needs several Claims Specialists to join our growing Outside Plant Damage Recovery team in Charlotte, NC. The ideal candidates will be initiative-taking go-getters, have strong organizational skills, be exceptional communicators, have an analytical and bold personality, and thrive in a commission...