Senior Claims Adjuster - Workers Compensation

PMA Companies • Gary, IN, United States • $200k - $250k / year • 4w ago

Description

Job Description:

As 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.

#LI-Remote

Qualifications

Requirements:

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 Indianajurisdiction is required; MN, IL and IA jurisdictional knowledge a plus.
Indiana or reciprocal license 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%.

#J-18808-Ljbffr

Related Jobs

Senior Analyst - IAM (REMOTE)

United Airlines • East Chicago, IN, United States • $200k - $250k / year • 3w ago

Finance Senior Level

3w ago

Senior Financial Analyst - Global Manufacturer- Dyer, IN

Michael Page US • Dyer, IN, United States • $200k - $250k / year • 3w ago

Finance Senior Level

3w ago

Senior or Lead Auditor (hybrid)

NiSource • Merrillville, IN, United States • $200k - $250k / year • 1m ago

Finance Senior Level

1m ago

Machine Learning Senior Quantitative Researcher (Fully Remote)

J.K. Barnes • East Chicago, IN, United States • $200k - $250k / year • 1m ago

Finance Senior Level

1m ago

Private Equity Analyst - 119th Street Capital

Centier Bank • Merrillville, IN, United States • $200k - $250k / year • 3w ago

Finance

3w ago

Field Market Access and Reimbursement Manager (REMOTE Eastern US)

Stryker • Portage, IN, United States • $200k - $250k / year • 3w ago

Finance

3w ago

Actuarial Lead Analyst - Remote

The Cigna Group • East Chicago, IN, United States • $200k - $250k / year • 3w ago

Finance

3w ago

Packed Ware Auditor 1

Ardagh Group • Dolton, IL, United States • $200k - $250k / year • 3w ago

Finance

3w ago

Life Insurance Consultant

Meron Financial Agency • Gary, IN, United States • $200k - $250k / year • 3w ago

Finance

3w ago

Lead Paint Removal Specialist - Join Our Dynamic Team in Dyer!

Job Hopper • Dyer, IN, United States • $200k - $250k / year • 4w ago

Finance

4w ago