Claims Adjuster I - Workers Compensation
PMA Companies is seeking Claims Adjusters to support new business growth and expansion in our Eastern Region. Opportunities exist in both our Insurance Company and TPA operations. This is an exciting opportunity to join an established company with incredible growth potential.As a member of our Claims team, utilize your knowledge of Workers Compensation Claims to independently investigate, evaluate and resolve assigned lost time claims of a moderate to complex nature in order to achieve appropriate outcomes. In this position you will administer and resolve Workers Compensation claims in a timely manner in accordance with legal statues, policy provisions and company guidelines.Responsibilities:Promptly investigates all assigned claims with minimal supervision.Determines coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable).Alerts Supervisor and Special Investigations Unit to potentially suspect claims.Ensures timely denial or payment of benefits in accordance with jurisdictional requirements.Within granted authority, establishes appropriate reserves with documented rationale, maintains and adjusts reserves over the life of the claim to reflect changes in exposure.Negotiates claims settlements within granted authority.Establishes and implements appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition.Works collaboratively with PMA nurse professionals to develop and execute return to work strategies.Selects and manages service vendors to achieve appropriate balance between allocated expense and loss outcome.Maintains a working knowledge of jurisdictional requirements and applicable case law for each state serviced.Demonstrates technical proficiency through timely, consistent execution of best claim practices.Communicates 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 but not limited to day to day interactions, claims reviews and stewardship meetings.Authorizes treatment based on the practiced protocols established by statute or the PMA Managed Care department.Assists PMA clients by suggesting panel provider information in accordance with applicable state statutes.Demonstrate commitment to Company's Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.Bachelor's degree or four years of equivalent work experience.At least 1-2 years of experience handling lost time workers compensation claims in designated jurisdiction.Claims Adjuster license, as required by designated jurisdiction.Associates in Claims (AIC) designation or similar professional designation a plus. Ability to work independently, handle multiple tasks simultaneously and make time sensitive decisions.Excellent customer service skills.Ability to prepare reports and present information to external customers and management.Strong organizational skills.Proven critical thinking skills that demonstrate analysis/judgment and sound decision making.Computer literacy, including working knowledge of MS Office - Word, Excel and PowerPoint. Claims Center knowledge a plus. Ability to travel for business purposes, approximately less than 10%.