Associate Claims Specialist - MO Workers Compensation - Tampa, FL

PMA Companies; Tampa (FL); Remote; USD 48,000 - 64,000; Full time

Job summary

PMA Companies in Tampa, FL seeks an Associate Claims Specialist. You will proactively manage medical-only and limited lost time claims to minimize losses and ensure timely filings, while maintaining superior service.

Key duties include contacting accounts on first notices of loss, processing payments, coordinating with providers, and maintaining an organized diary for follow-up. The role requires medical terminology knowledge, independent work, and MS Excel/Word proficiency; licensure within 90

Qualifications

• Requires 1+ years Workers' Compensation claims handling experience.
• License required or obtainable within 90 days in mandated states.
• Familiarity with medical terminology.
• Ability to work independently and manage multiple tasks.
• Strong organizational and communication skills.

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.
• Complete contacts within 24 hours; maintain a diary for follow-up.
• Determine treatment appropriateness and causal relation to injury.
• Redirect treatment to network physicians as appropriate.
• Refer subrogation or permanency potential claims to Supervisor.
• Ensure compliance with jurisdictional requirements on Medical Only claims; timely filings.
• Maintain knowledge of state adjusting licenses and renew as needed.
• Administer benefits on Permanent Total or Death cases; monitor life/work status and costs.
• Adhere to Code of Business Conduct and Ethics; apply compliance policies.

Skills

Communication skills

Organizational skills

Detail oriented

Independent work

Education

High school diploma or equivalent

Tools

MS Excel

MS Word

Job description

Associate Claims Specialist

#4927

Tampa, Florida, United States

#LI-Remote

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.

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.

Alternate Location(s)

Tampa, Florida, United States