Claims Resolution Specialist
1 day ago
We are seeking a skilled Claims Resolution Specialist to join our team at PMA Companies. As a Claims Resolution Specialist, 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.
- Alert supervisors and special investigations units to potentially suspect claims.
- Ensure timely denial or payment of benefits in accordance with jurisdictional requirements.
- Negotiate claims settlements within granted authority.
- Establish and implement 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 an appropriate balance between allocated expense and loss outcome.
- Maintain a working knowledge of New York jurisdictional requirements and applicable case law for each state serviced.
- Demonstrate technical proficiency through timely and consistent execution of best claim practices.
- Communicate effectively with internal and external parties on a wide variety of claims and account issues.
- Bachelor's degree and/or four or more years of equivalent work experience in an insurance-related industry.
- Florida and Georgia jurisdiction experience.
- Associate in Claims (AIC) designation or similar professional designation desired.
- License required or ability to obtain license within 90 days of employment in mandated states.
- Familiarity with medical terminology and/or Workers' Compensation.
- Working knowledge of Workers Compensation regulations, preferably jurisdiction-specific.
- 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 gained through previous work experience.
- Computer literacy, including working knowledge of MS Office Product Suite.
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Claims Resolution Specialist
3 weeks ago
Tampa, Florida, United States PMA Companies Full timeJob Title: Claims Resolution SpecialistWe are seeking a skilled Claims Resolution Specialist to join our team at PMA Companies. As a Claims Resolution Specialist, 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...
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Claims Resolution Specialist
2 weeks ago
Tampa, Florida, United States PMA Companies Full timeJob Title: Claims Resolution SpecialistWe are seeking a skilled Claims Resolution Specialist to join our team at PMA Companies. As a Claims Resolution Specialist, 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...
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Claims Resolution Supervisor
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Claims Resolution Supervisor
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