Senior Account Claims Representative

2 weeks ago


Minneapolis, United States PMA Companies Full time
Senior Account Claims Representative - Workers Compensation #4252 Multiple Locations Apply for this job now Job Description:

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.

#LI-Remote

Requirements:

Requirements:

  • 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 MN and/or GA jurisdiction is required and applicable licenses.
  • Assigned Risk experience highly desired.
  • 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%.
Locations Albany Atlanta Augusta Columbus Macon Savannah Duluth Minneapolis Saint Paul St Louis Park St. Cloud

  • Minneapolis, Minnesota, United States PMA Companies Full time

    Senior Account Claims Representative - Workers Compensation #4252 Multiple Locations Apply for this job now Job Description: 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...


  • Minneapolis, United States PMA Companies Full time

    Senior Account Claims Representative #4252 Multiple Locations Apply for this job now! Job Description: 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...


  • Minneapolis, United States PMA Companies Full time

    Senior Account Claims Representative - Workers Compensation #4252 Multiple Locations Apply for this job now! Job Description: 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...

  • Senior Claims Adjuster

    2 months ago


    Minneapolis, Minnesota, United States PMA Companies Full time

    Senior Claims Adjuster - Workers Compensation - MN experience #4194 Multiple Locations Apply for this job now Job Description: 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...


  • Minneapolis, United States Minnesota Visiting Nurse Agency Full time

    *SUMMARY* We are currently seeking an RCM Representative Senior to join our *Third-Party Claims- HB & PB *team. This full-time role will primarily work remotely (SHIFT: Day). Purpose of this position: Working under general supervision, provides revenue cycle services to incoming and existing patients and their families either in person or by telephone....


  • Minneapolis, United States Hennepin County Medical Center Full time

    Hennepin Healthcare is an integrated system of care that includes HCMC, a nationally recognized Level I Adult Trauma Center and Level I Pediatric Trauma Center and acute care hospital, as well as a clinic system with primary care clinics located in Minneapolis and across Hennepin County. The comprehensive healthcare system includes a 473-bed academic medical...


  • Minneapolis, Minnesota, United States RGA Reinsurance Company Full time

    Job SummaryWe are seeking a highly skilled and experienced Senior Claims Examiner to join our team at RGA Reinsurance Company. As a Senior Claims Examiner, you will be responsible for managing all aspects of analyzing high-dollar claims and determining eligibility for complex Group Reinsurance claims.Key ResponsibilitiesClaims Analysis and Eligibility:...


  • Minneapolis, North Carolina, United States Securian Financial Full time

    Position Overview:This role serves as a key authority on supplemental health claim management within the employer sector, offering guidance and support to various business functions, channel partners, and clients.Key Responsibilities:Engage in effective communication with claimants, clients, business partners, claims specialists, and senior management.Act as...


  • Minneapolis, Minnesota, United States Brookdale Senior Living Full time

    Job SummaryWe are seeking a highly motivated and experienced Senior Sales Representative to join our team at Brookdale Senior Living. As a Senior Sales Representative, you will be responsible for promoting our senior living communities and generating new business opportunities.Key ResponsibilitiesLead Generation: Identify and pursue new business...

  • Account Representative

    3 months ago


    Minneapolis, Minnesota, United States DCM Services, LLC Full time

    ApplyDescriptionRemote in Tennessee only at this time.We are having a large amount of growth and due to that have many Account Representative positions open Come join a team of fun, dedicated, hardworking individuals and make your next move your best moveWho are we?DCM Services provides specialized receivable solutions to our clients. Our culture is what...


  • Minneapolis, United States Intact Insurance Full time

    Job Description We currently have an opportunity for a Senior Reinsurance Claims Analyst to join our Corporate Reinsurance & Reserving team in our Plymouth, MN office. This role is responsible for timely and accurate identification, analysis, reporting/billing and collection of ceded reinsurance claims for the US business. Responsibilities: Monitors...


  • Minneapolis, Minnesota, United States Western National Insurance Group Umialik Insurance Company Full time

    Job TypeFull-timeAbout UsWestern National Insurance Group is a well-established mutual insurance provider with a rich history of over 120 years in delivering property and casualty insurance solutions across the Midwestern, Northwestern, and Southwestern regions of the United States. Renowned as "The Relationship Company," we prioritize the quality of the...


  • Minneapolis, United States Hennepin County Medical Center Full time

    Hennepin Healthcare is an integrated system of care that includes HCMC, a nationally recognized Level I Adult Trauma Center and Level I Pediatric Trauma Center and acute care hospital, as well as a clinic system with primary care clinics located in Minneapolis and across Hennepin County. The comprehensive healthcare system includes a 473-bed academic medical...


  • Minneapolis, United States Hennepin County Medical Center Full time

    Hennepin Healthcare is an integrated system of care that includes HCMC, a nationally recognized Level I Adult Trauma Center and Level I Pediatric Trauma Center and acute care hospital, as well as a clinic system with primary care clinics located in Minneapolis and across Hennepin County. The comprehensive healthcare system includes a 473-bed academic medical...


  • Minneapolis, Minnesota, United States Western National Insurance Group Umialik Insurance Company Full time

    Job TypeFull-timeAbout UsWestern National Insurance Group is a well-established mutual insurance provider with a rich history of over 120 years, dedicated to meeting the property-and-casualty insurance needs of clients across the Midwestern, Northwestern, and Southwestern regions of the United States. Renowned as "The Relationship Company," we measure our...


  • Minneapolis, Minnesota, United States Western National Group & Umialik Insurance Full time

    Job OverviewAbout Us:Western National Insurance Group is a longstanding mutual insurance provider with a rich history of over 120 years, dedicated to fulfilling the property-and-casualty insurance requirements of clients across the Midwestern, Northwestern, and Southwestern regions of the United States. Renowned as "The Relationship Company," we prioritize...


  • Minneapolis, Minnesota, United States Fox Point Recruitment LLC Full time

    Job DescriptionAre you looking for a rewarding career where you know you're making a difference in people's lives? Our client in the financial services sector is seeking a Senior Property Claims Representative to join their field claims team.This role operates in a work-from-home and virtual office environment with a mobile office/company vehicle to work...


  • Minneapolis, United States Western National Insurance Group Umialik Insurance Company Full time

    Job Type Full-time Description Who are we? Western National Insurance Group is a private mutual insurance company with over 120 years of experience serving customers' property-and-casualty insurance needs in the Midwestern, Northwestern, and Southwestern United States. Known as "The Relationship Company®," we define success as a measure of the relationships...


  • Minneapolis, Minnesota, United States Western National Group & Umialik Insurance Full time

    Position OverviewAbout Us:Western National Insurance Group is a well-established mutual insurance provider with a legacy of over 120 years in addressing the property-and-casualty insurance requirements of clients across the Midwestern, Northwestern, and Southwestern regions of the United States. We pride ourselves on being "The Relationship Company," where...


  • Minneapolis, United States Western National Group & Umialik Insurance Full time

    Job DescriptionJob DescriptionDescription:Who are we?Western National Insurance Group is a private mutual insurance company with over 120 years of experience serving customers' property-and-casualty insurance needs in the Midwestern, Northwestern, and Southwestern United States. Known as “The Relationship Company®,” we define success as a measure of...