Job details

Senior Claims Adjuster - Workers Compensation

Job DescriptionAs a member of our claims team, 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 accordance with legal statues, policy provisions, and company guidelines.Responsibilities• Promptly investigate all 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 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 the 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.• 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.RequirementsRequirements:• Bachelor's degree, or four or more years of equivalent work experience required in an insurance related industry required• At least 3-5 years' experience handling lost time workers compensation claims required; past experience with 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, i.e. Word, Excel, PowerPoint.• Ability to travel for business purposes, approximately less than 10%.

PMA Companies Glassdoor Company Review

3.9

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No rating

CEO of PMA Companies

John Santulli

Approve of CEO

Average salary estimate

$80000 / YEARLY (est.)

min

max

$70000K

$90000K

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What You Should Know About Senior Claims Adjuster - Workers Compensation, PMA Companies

Are you ready to take your career to the next level as a Senior Claims Adjuster - Workers Compensation at our company in Danbury, CT? This role is perfect for someone who thrives in a collaborative environment and is eager to leverage their expertise in Workers Compensation to independently handle more complex claims. Your responsibilities will include investigating claims promptly with minimal supervision, determining coverage and compensability, and ensuring alignment with legal statutes and company guidelines. As a Senior Claims Adjuster, you will be responsible for setting appropriate reserves, negotiating settlements, and developing action plans for effective case resolution—collaborating closely with PMA nurse professionals to strategize return-to-work initiatives. You'll also play a crucial role in managing vendor relationships to optimize outcomes. What’s more, you'll maintain a thorough understanding of jurisdictional requirements and commit to best claim practices, all while providing exceptional customer service during claims reviews and meetings. Join us, where your critical thinking skills and attention to detail will empower you to make significant contributions to the claims process!

Frequently Asked Questions (FAQs) for Senior Claims Adjuster - Workers Compensation Role at PMA Companies

What are the primary responsibilities of a Senior Claims Adjuster - Workers Compensation at our company?

As a Senior Claims Adjuster - Workers Compensation, your primary responsibilities will include independently investigating complex claims, determining coverage and compensability, managing reserves, and negotiating settlements. You will also establish action plans for case resolution and work collaboratively with medical professionals to ensure effective return-to-work strategies.