Senior Lost Time Claims Adjuster

3 weeks 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%.

  • Claims Adjuster

    4 weeks ago


    Charlotte, North Carolina, United States Insurance Placement Solutions Full time

    Insurance Placement Solutions has an immediate opening for a Remote Workers Compensation Claims Adjuster with our client. As a member of our client's claims team, utilize your knowledge of workers compensation to independently investigate, evaluate and resolve assigned claims in order to achieve appropriate outcomes. In this position, you will administer and...


  • Charlotte, United States PMA Companies Full time

    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...


  • Charlotte, United States PMA Companies Full time

    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...


  • Charlotte, United States PMA Companies Full time

    Job Description: 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...

  • Property Adjuster I

    4 days ago


    Charlotte, United States Erie Insurance Group Full time

    Exercises independent discretion or judgment in handling property claims within designated level of authority. Also responsible for servicing assigned territory and may handle litigated claims. Experience in Property Adjusting Preferred This is a rem Property Adjuster, Property, Adjuster, Claims, Insurance


  • Charlotte, United States PMA Companies Full time

    As a member of our Claims management team supervise claims staff to ensure appropriate claim outcomes through consistent execution of best claims practice. In this role utilize your prior claims and management experience to achieve business plan goals and to ensure compliance with legal statutes, policy provisions and company guidelines while fostering a...


  • Charlotte, United States PMA Companies Full time

    Job Description: As a member of our Claims management team supervise claims staff to ensure appropriate claim outcomes through consistent execution of best claims practice. In this role utilize your prior claims and management experience to achieve business plan goals and to ensure compliance with legal statutes, policy provisions and company guidelines...

  • Claims Counsel

    2 weeks ago


    Charlotte, United States Carolina Legal Staffing Full time

    We are working with a Company on a search for an experienced In-House Insurance Claims Counsel for their corporate legal department located in uptown Charlotte. The company is a group of property/casualty insurance companies writing a wide variety of commercial, personal, admitted and surplus lines insurance business nationwide with offices in Charlotte,...

  • Claims Counsel

    3 weeks ago


    Charlotte, United States Carolina Legal Staffing Full time

    We are working with a Company on a search for an experienced In-House Insurance Claims Counsel for their corporate legal department located in uptown Charlotte. The company is a group of property/casualty insurance companies writing a wide variety of commercial, personal, admitted and surplus lines insurance business nationwide with offices in Charlotte,...

  • Claims Counsel

    4 weeks ago


    Charlotte, United States Carolina Legal Staffing Full time

    We are working with a Company on a search for an experienced In-House Insurance Claims Counsel for their corporate legal department located in uptown Charlotte. The company is a group of property/casualty insurance companies writing a wide variety of commercial, personal, admitted and surplus lines insurance business nationwide with offices in Charlotte,...


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

    Our client, an A-rated Insurance Carrier, is seeking to add a Commercial General Liability Claims Representative to their North Carolina team. This person would be responsible for directly handling moderate to complex non-litigated Commercial General Liability claims including Slip and Falls, Premise Liability, and Bodily Injury losses throughout the...


  • Charlotte, United States Command Investigations Full time

    Job DescriptionJob DescriptionSeeking experienced Investigators/Adjusters for insurance investigations that include Recorded Statements as well as Scene and industrial/workplace accidents. We are seeking individuals who possess proven investigative skill sets within the industry. Honesty, integrity, self-reliance, resourcefulness, independence, discipline,...


  • Charlotte, United States Sunrise Senior Living Full time

    Overview"Sunrise is the best place that I've ever worked, simply because of the people. We provide quality care in an environment that feels like home. Our focus is doing what's right for the resident. For me, that's a big breath of fresh air."- Sunrise Leader  At Sunrise, our Senior Resident Care Director (Sr. RCD) is responsible for providing overall...


  • Charlotte, United States Startekk Inc Full time

    Job DescriptionJob DescriptionCompany DescriptionIn short, StarTekk is a global IT firm that specializes in the following:OutsourcingConsultingEnterprise software mobilityWeb/mobile app developmentCloud based solutionsIntegrity, courage and dependability are very important to us. We always strive to build long lasting relationships with the community and...


  • Charlotte, United States Navion Senior Solutions Full time

    Job DescriptionJob DescriptionPreston House, a community of Navion Senior Living, is seeking cooks to assist in the preparation, oversight, and serving of meals. Our cooks are responsible for delivering top notch food service in a high-quality, cutting edge Community. The successful candidates will employ their culinary and managerial skills in order to play...


  • Charlotte, United States Palmer & Cay Full time

    Property & Casualty Senior Client Advisor Atlanta, Georgia & Charlotte, North Carolina Palmer & Cay is a privately held specialty insurance and employee benefits firm with highly experienced and motivated professionals who are united in their commitment to providing exceptional client consulting services. The Senior Client Advisor at Palmer & Cay is central...


  • Charlotte, United States Navion Senior Solutions Full time

    Preston House is seeking Certified Medication Technicians for medication administration-related roles. Our Medication Technicians are responsible for delivering high-quality medication administration and resident care oversight in a cutting-edge Assisted Living and/or Memory Care Community. Full-Time Shifts and Part-Time Shifts Available.Responsibilities ...


  • Charlotte, North Carolina, United States Sunrise Senior Living Full time

     : Sunrise Senior Living was again certified as a Great Place to Work® by Activated Insights. This is the 6th time Sunrise has received this top culture and workplace designation, highlighting the special place Sunrise is to be a part of. COMMUNITY NAME: Charlotte, NC - Metro Area Job ID: (phone number removed) JOB OVERVIEW: "Sunrise is the best place...

  • Legal Assistant

    3 weeks ago


    Charlotte, United States Mark Farbman P A Full time

    Job DescriptionJob DescriptionCharlotte Personal Injury Firm is looking for a full-time legal assistant to assist with normal daily office tasks. The job will consist of answering phones, giving client case updates, requesting and following up on medical records and bills, speaking with adjusters and setting up claims, etc. The schedule is 9-5 with health...


  • Charlotte, United States CenterWell Senior Primary Care Full time

    The Primary Care Physician (PCP) works as a lead in our team-based care environment. We are a value based care provider focused on quality of care for the patients we serve. Our care team consists of doctors, advanced practice professionals, Pharm D, care coach nurses, MAs, behavioral health specialists, quality based coders, referral coordinators and more....