Sr. Account Claims Representative-WC
PMA Capital Corporation - Charlotte, NC

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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 for self insured 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 .

Qualifications:
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 North Carolina jurisdiction is required

Associate in Claims (AIC) Designation or similar professional designation desired.

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%.

As a leader in the property and casualty insurance industry with multiple locations, our clients choose PMA Companies because we understand that excellent service begins with our employees. Our working relationships with clients are marked by professionalism, execution and accountability and our company culture is centered on teamwork. This combination creates a supportive work environment that encourages personal and professional growth.

We offer a very competitive compensation package including a 401(k) with dollar for dollar match on the first 5% of salary, tuition reimbursement and much more!.

PMA Capital Corporation - 14 months ago - save job - block