Corporate Claims Consultant - Blue Bell, PA

PMA Companies; Center Square (PA); Remote; USD 90,000 - 120,000; Full time

Job summary

PMA Companies seeks a Corporate Claims Consultant to provide technical direction for complex claims and oversee QA and policy compliance. This role supports TPAs and bundled claims, with remote work options.

The position emphasizes leadership, training, and collaboration while ensuring adherence to industry standards and corporate procedures. CPCU/AIC or similar credentials are preferred.

Qualifications

• Bachelor's degree or 5+ years of equivalent work experience in an insurance related industry.
• Extensive knowledge of insurance contracts and adjusting techniques. Familiarity with medical terminology.
• Demonstrated leadership, coaching, and teamwork skills.
• Advanced skills in applying sound judgment/analysis, decision making/problem solving, planning and organization and negotiation.
• Demonstrated customer service and collaboration skills.
• Excellent verbal and written communication skills.
• Computer literacy, including working knowledge of MS Office Product Suite, i.e. Word, Excel, PowerPoint.
• Previous supervisory experience, CPCU and AIC, or similar professional designation, desired.

Responsibilities

• Provide technical oversight for unbundled claims assigned to TPA partners with reserve and settlement authority.
• Provide overflow support to bundled claims handled by PMAIC field claims with authority above field limits.
• Directly handle assigned pending corporately established liability files.
• Support compliance activities related to TPAs.
• Support QA processes to assess and improve work quality.
• Lead projects to resolve corporate claims issues and communicate policies.
• Assess training needs and conduct performance-focused training.
• Uphold the Company's Code of Business Conduct and Ethics in daily work.

Skills

Leadership

Coaching

Teamwork

Decision making

Negotiation

Communication

Customer service

Planning & organizing

Problem solving

Training staff

Education

Bachelor's degree or 5+ years experience

CPCU

AIC

Tools

MS Office

Word

Excel

PowerPoint

Job description

Corporate Claims Consultant

#4930

Provides the highest level of technical direction to the claims staff to ensure appropriate outcomes for claims of the most complex nature. Executes quality assurance programs to evaluate staff adherence to the claim handling standards. Develops and ensures compliance with corporate policies and procedures.

Responsibilities

• Provide technical oversight for unbundled claims assigned to TPA partners inclusive of reserve and settlement authority in excess of TPA discretionary authority limits.
• Provide overflow support to bundled claims handled by PMAIC field claims inclusive of reserve and settlement authority in excess of field authority
• Direct handle an assigned pending of corporately established liability files
• Provide support to various compliance related activities relative to TPA's
• Support Quality Assurance processes to assess quality of work product, identify improvement opportunities and foster discussions that are focused on solutions to enhance results.
• Develops, communicates and ensures compliance with corporate policies and procedures. Leads project teams focused on resolving corporate claims issues.
• Assesses staff training needs and conducts training focused on improving performance.
• 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

• Bachelor's' degree or 5 or more years of equivalent work experience in an insurance related industry required.
• Extensive knowledge of insurance contracts and adjusting techniques. Familiarity with medical terminology.
• Demonstrated leadership, coaching, and teamwork skills.
• Advanced skills in applying sound judgment/analysis, decision making/problem solving, planning and organization and negotiation.
• Demonstrated customer service and collaboration skills.
• Excellent verbal and written communication skills.
• Computer literacy, including working knowledge of MS Office Product Suite, i.e. Word, Excel, PowerPoint.
• Previous supervisory experience, Chartered Property Casualty Insurance (CPCU) and Associate in Claims (AIC), or similar professional designation, desired.

Alternate Location(s)

• Tampa, Florida, United States
• Atlanta, Georgia, United States
• Baltimore, Maryland, United States
• Mount Laurel, New Jersey, United States
• De Witt, New York, United States
• Blue Bell, Pennsylvania, United States
• Glen Allen, Virginia