Senior Claims Representative

20 hours ago


Montpelier, Vermont, United States PMA Companies Full time
Job Title: Senior Claims Representative

We are seeking a highly skilled and experienced Senior Claims Representative to join our team at PMA Companies. As a key member of our claims team, you will be responsible for investigating, evaluating, and resolving complex workers' compensation claims in a timely and efficient manner.

Key Responsibilities:
  • Investigate and evaluate complex workers' compensation claims to determine coverage, compensability, and potential for subrogation recovery.
  • Develop and implement effective action plans to resolve claims, including medical and disability management, litigation management, negotiation, and disposition.
  • Work collaboratively with PMA nurse professionals to develop and execute return-to-work strategies.
  • Manage service vendors to achieve optimal balance between allocated expense and loss outcome.
  • Stay up-to-date with jurisdictional requirements and applicable case law for each state serviced.
  • Communicate effectively with internal and external parties on a wide range of claims and account issues.
  • Provide exceptional customer service to clients, including face-to-face interactions during claims reviews and stewardship meetings.
Requirements:
  • Bachelor's degree or four or more years of equivalent work experience in an insurance-related industry.
  • At least 3-5 years of experience handling lost-time workers' compensation claims, with past experience in Vermont jurisdiction 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 ability to work independently and deal effectively with multiple tasks simultaneously.
  • Proven critical thinking skills, with ability to analyze, judge, and make sound decisions with attention to detail.
  • Strong verbal, written communication skills, and customer service skills.
  • Computer literacy, including working knowledge of MS Office Product Suite.


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