Lost Time Claims Adjuster II - Workers Compensation - Remote
Company: PMA Companies
Location: Charlotte
Posted on: September 18, 2023
Job Description:
As a member of our Claims team, 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 accordance with legal statues, policy provisions, and
company guidelines.
- Responsibilities:
- Promptly investigates all assigned claims with minimal
supervision, including those of a more complex nature
- 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 New York 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
- Provides a high degree of customer service to clients,
including face to face interactions during claims reviews,
stewardship meetings and similar account-specific sessions
- 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 and/or four or more years of equivalent work
experience required in an insurance related industry
required
- North Carolina 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, i.e. Word, Excel, PowerPoint
- Ability to travel for business purposes, approximately less
than 10%.
Keywords: PMA Companies, Charlotte , Lost Time Claims Adjuster II - Workers Compensation - Remote, Other , Charlotte, North Carolina
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