Claims Associate II
2 weeks ago
As a key member of our Claims team at PMA Companies, you will play a critical role in managing medical only and limited lost time claims to minimize losses. Your expertise will also be applied to permanent total claims to ensure effective management and superior customer service.
Responsibilities:
Proactively contact accounts on First Notices of Loss to obtain essential information for file setup
Process payments, answer phone calls, and authorize treatment associated with Medical Only claims
Complete necessary contacts within 24 hours of assignment and maintain a diary for follow-up
Determine whether treatment is appropriate and causally related to the compensable injury
Redirect treatment to network physicians as needed
Refer subrogation potential claims or potential permanency claims to your supervisor
Ensure compliance with jurisdictional requirements on Medical Only claims, including timely form filing if applicable
Maintain a working knowledge of jurisdictional requirements and obtain/maintain state adjusting licenses
Administer benefits on Permanent Total or Death cases, monitoring for changes in life or work status, implied interest in resolution, or marked increases in costs
Demonstrate commitment to our Company's Code of Business Conduct and Ethics, applying knowledge of compliance policies and procedures, standards, and laws applicable to job responsibilities
High school diploma or equivalent required
One or more years of Workers Compensation claims handling experience
License required or ability to obtain license within 90 days of employment in mandated states
Familiarity with medical terminology
Ability to work independently, handle multiple tasks simultaneously, make difficult decisions, and focus on details
Strong organizational skills
Excellent verbal and written communication skills
Proficiency in MS Excel and MS Word
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