Senior Claims Adjuster - Workers Compensation at PMA Companies

Whitpain Township, Pennsylvania, United States -

Full Time

Start Date

Immediate

Expiry Date

11 Oct, 26

Salary

0.0

Posted On

13 Jul, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Workers Compensation Claims Handling, Claims Investigation, Reserve Management, Settlement Negotiation, Medical Case Management, Litigation Management, Subrogation Recovery, Jurisdictional Compliance, Customer Service, Medical Terminology

Industry

Insurance

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 Lodestar 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 Lodestar Managed Care department * Assist Lodestar 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 PA 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

Responsibilities

Independently investigate, evaluate, and resolve complex Workers Compensation claims while ensuring compliance with legal statutes and company guidelines. This includes managing reserves, negotiating settlements, and collaborating with medical professionals to execute return-to-work strategies.