Associate Claims Specialist - Roseville, CA

PMA Companies; Roseville (CA); Remote; USD 58,000 - 73,000; Full time

Job summary

PMA Companies seeks an Associate Claims Specialist to join the Roseville, CA team. You will manage medical only and limited lost time claims, ensuring timely setup, processing payments, and coordinating with network physicians.

The role requires 1+ year of workers' compensation claims handling, a high school diploma or equivalent, and the ability to obtain state licenses within 90 days. Strong communication and organizational skills are essential for success.

Qualifications

• 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 in mandated states.
• Familiarity with medical terminology.
• Ability to work independently and manage multiple tasks.
• Strong organizational skills.
• Excellent verbal and written communication skills.
• Proficiency MS Excel and MS Word.

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 of assignment and maintain follow-up diaries.
• Determine whether treatment is appropriate and causally related to the injury.
• Redirect treatment to network physicians as appropriate.
• Refer subrogation or permanency claims to Supervisor.
• Ensure compliance with jurisdictional requirements on Medical Only claims and filing.

Skills

Workers' Compensation claims handling

MS Excel

MS Word

Education

High school diploma or equivalent

Tools

MS Excel

MS Word

Job description

Associate Claims Specialist #4909

Roseville, California, United States

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

#LI-Remote

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)

Roseville, California, United States