Claims Associate II

2 weeks ago


Glastonbury, Connecticut, United States PMA Companies Full time

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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