Claims Resolution Specialist

1 week ago

Tampa, Florida, United States PMA Companies Full time
Job Title: Claims Resolution Specialist

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 unit 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.
  • Provide a high degree of customer service to clients, including face-to-face interactions during claims reviews, stewardship meetings, and similar account-specific sessions.
Requirements:
  • 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.

PMA Companies is an equal opportunity employer and welcomes applications from diverse candidates. If you are a motivated and detail-oriented individual with a passion for claims resolution, we encourage you to apply for this exciting opportunity.

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