Senior Lost Time Claims Adjuster - Workers Compensation - Remote
Company: PMA Companies
Location: Glen Allen
Posted on: January 26, 2023
Job Description:
PMA, an Old Republic Company, has a unique, fully remote
opportunity for an experienced Multi-state Workers Compensation
Claims Adjuster on our exclusive full-time permanent Regional
Technical Support Team! Bring your expertise to our group of highly
regarded claims professionals who play a critical role in our
organization's success. Enjoy work/life balance filling in for our
adjusters who are on vacation or leave to keep their desks moving
forward and our clients satisfied. If you like variety, are
solution oriented and team focused but no longer want the
responsibility of handling claim reviews and an ongoing pending
this is the role for you! 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.
Keywords: PMA Companies, Richmond , Senior Lost Time Claims Adjuster - Workers Compensation - Remote, Other , Glen Allen, Virginia
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