Senior Claims Specialist
1 week ago
We are seeking a highly skilled and experienced Claims Representative to join our team at PMA Companies. As a member of our claims team, you will utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature.
Key Responsibilities- Investigate and evaluate 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 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 appropriate balance between allocated expense and loss outcome.
- Maintain a working knowledge of jurisdictional requirements and applicable case law for each state serviced.
- Demonstrate technical proficiency through timely, consistent execution of best claim practices.
- Communicate effectively, verbally and in writing, 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.
- Authorize treatment based on practiced protocols established by statute or the PMA Managed Care department.
- Assist PMA clients by suggesting panel provider information in accordance with applicable state statutes.
- Bachelor's degree or four or more years of equivalent work experience in an insurance related industry.
- At least 3-5 years' experience handling lost time workers compensation claims.
- Past experience with MA, RI, VT, NH, and CT 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.
- 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.
- Computer literacy, including working knowledge of MS Office Product Suite.
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Claims Resolution Specialist
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Stratford, Connecticut, United States PMA Companies Full timeJob Title: Senior Claims RepresentativeAs a key member of our claims team, you will utilize your expertise in Workers Compensation to independently investigate, evaluate, and resolve assigned claims of a more complex nature. Your goal will be to achieve appropriate outcomes in a timely manner, in accordance with legal statutes, policy provisions, and company...
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Senior Claims Examiner
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Stratford, Connecticut, United States PMA Companies Full timeJob Title: Senior Claims RepresentativeAs a member of our claims team, you will utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes.Key Responsibilities:Promptly investigate all assigned claims with minimal supervision, including...
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Stratford, Connecticut, United States PMA Companies Full timeAs a key member of our claims team at PMA Companies, you will utilize your expertise in Workers Compensation to independently investigate, evaluate, and resolve assigned claims of a more complex nature to achieve optimal outcomes.In this position, you will administer and resolve high-risk management expectations claims in a timely manner in accordance with...
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Stratford, Connecticut, United States PMA Companies Full timeAs a member of our claims team at PMA Companies, you will utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes.In this position, you will administer and resolve highest risk management expectations claims in a timely manner in...
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Stratford, Connecticut, United States PMA Companies Full timeAs a member of our Claims team at PMA Companies, you will utilize your knowledge of Workers Compensation Claims to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes.In this position, you will administer and resolve highest risk management expectations claims in a timely manner in...
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