Workers Compensation Investigator
1 week ago
About the Role:
PMA Companies is seeking a highly skilled Workers Compensation Investigator to join our team. As a key member of our claims department, you will be responsible for investigating, evaluating, and resolving complex workers compensation claims.
Key Responsibilities:
- Investigate assigned claims with minimal supervision, including those of a more complex nature.
- Determine coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable).
- Alert Supervisor and Special Investigations Unit to potentially suspect claims.
- Ensure timely denial or payment of benefits in accordance with jurisdictional requirements.
- Establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure.
- Negotiate claims settlements with client approval.
- Establish and implement appropriate 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 jurisdictional requirements and applicable case law for each state serviced.
Requirements:
- Bachelor's degree, or four or more years of equivalent work experience required in an insurance-related industry.
- At least 3-5 years' experience handling lost-time workers compensation claims required; past experience with Vermont jurisdiction is 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.
Compensation:
The estimated salary for this role is $60,000 - $80,000 per year, depending on experience.
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