Advanced Claims Adjuster for Complex Cases

1 week ago


Boston, Massachusetts, United States PMA Companies Full time

Become a vital member of our claims department and leverage your knowledge in Workers Compensation to thoroughly investigate, assess, and resolve intricate claims. Strive for the best results by managing and settling high-stakes claims effectively while adhering to legal standards.

Key Responsibilities:

  • Conduct independent investigations on assigned claims, focusing on complex scenarios
  • Evaluate coverage, compensability, subrogation possibilities, and eligibility for second injury funds
  • Notify Supervisor and Special Investigations Unit regarding any suspicious claims
  • Ensure prompt payment or denial of benefits
  • Establish and modify reserves based on evolving claim exposures
  • Negotiate settlements with client consent
  • Develop action plans for case resolution, incorporating medical and disability management strategies
  • Work collaboratively with nursing professionals to facilitate return-to-work initiatives
  • Select and manage service vendors to optimize costs and outcomes
  • Stay informed about state-specific regulations and case law
  • Engage effectively with both internal and external stakeholders
  • Deliver outstanding customer service during client interactions
  • Authorize treatment in accordance with established protocols and statutory guidelines
  • Assist clients with recommendations for panel providers
  • Comply with the Company's ethical standards and regulatory policies

Qualifications:

  • Bachelor's degree or equivalent experience in the insurance sector
  • 3-5 years of experience managing workers compensation claims
  • Familiarity with MA, CT, VT, and RI jurisdictions
  • CT license required
  • Associate in Claims (AIC) designation is preferred
  • Strong organizational and analytical skills
  • Exceptional communication and customer service skills
  • Proficient in MS Office Suite


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