Associate Claims Specialist - Medical-Only - Workers Compensation

PMA Companies; Northern (KY); Hybrid; USD 58,000 - 73,000; Full time

Job summary

PMA Companies is hiring an Associate Claims Specialist for Medical-Only Workers Compensation. This remote role focuses on medical-only and limited lost time claims, handling first notices of loss, authorizing treatment, and ensuring regulatory compliance across jurisdictions.

The position requires at least a high school diploma and 1+ year of workers compensation claims handling, with a license obtainable within 90 days in mandated states.

Qualifications

• High school diploma or equivalent is required.
• One or more years of Workers Compensation claims handling experience.
• Ability to obtain or maintain state adjusting licenses within 90 days of employment.

Responsibilities

• Contact accounts on First Notices of Loss to obtain missing information for file setup.
• Process payments, answer calls, and authorize treatment for Medical Only claims.
• Maintain a diary and complete contacts within 24 hours of assignment.
• Determine treatment appropriateness and causally relate to the injury.
• Direct treatment to network physicians when appropriate.
• Refer subrogation or permanency claims to Supervisor.
• Ensure compliance with jurisdictional requirements for Medical Only claims.

Skills

Attention to detail

Organization

Verbal and written communication

Independent work

Education

High School Diploma or equivalent

Tools

MS Excel

MS Word

Job description

Associate Claims Specialist - Medical-Only - Workers Compensation

#4891

Multiple Locations

Job Description:

As a member of our Claims team, you will proactively manage medical only and limited lost time claims in order to minimize losses, manage permanent total claims in order to minimize losses, and provide superior customer service.

Responsibilities:

• Contact accounts on First Notices of Loss to obtain missing information pertinent to file set-up
• Process payments, answer phone calls, authorize treatment associated with Medical Only claims
• Complete appropriate contacts within 24 hours of assignment, and establish and maintain appropriate diary for follow-up
• Determine whether treatment is appropriate and causally related to the compensable injury
• Redirect treatment to network physicians as appropriate
• Refer subrogation potential claims or potential permanency claims to Supervisor
• Work to ensure compliance with all appropriate jurisdictional requirements on Medical Only claims, including timely form filing if applicable
• Maintain a working knowledge of jurisdictional requirements and obtain/maintain state adjusting licenses
• Administer benefits on Permanent Total or Death cases, which includes monitoring for changes in life or work status, implied interest in resolution or marked increases in costs.
• 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.
• Target Salary - $58,000 - $73,000

Requirements:

• High school diploma or equivalent
• One or more years of Workers Compensation claims handling experience
• License required or ability to obtain license within 90 days of employment in mandated states
• Familiarity with medical terminology
• Ability to work independently, handle multiple tasks simultaneously, make difficult decisions and focus on details
• Strong organizational skills
• Excellent verbal and written communication skills
• Proficiency MS Excel and MS Word.
• Remote position

Alternate Location(s)

• Irvine , California , United States
• Oakland , California , United States
• Redding , California , United States
• Anaheim , California , United States
• Fresno , California , United States
• Irvine , California , United States
• Oakland , California , United States
• Redding , California , United States

This Company is an Equal Opportunity Employer, and does not discriminate on the basis of race, gender, ethnicity, religion, national origin, age, disability, veteran status, or on any other basis prohibited by law. Information on race, gender and national origin will only be used for statistical and recordkeeping purposes, and will not be used in making any employment decisions. All information provided will be kept separate from your expression of interest. Providing this information is strictly voluntary, and you will not be subjected to any adverse action or treatment if you choose not to provide this information. If you do not choose to answer these questions, we ask that you select "Decline to Identify" for each question. Thank you for your voluntary cooperation.

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