Senior Claims Adjuster - Workers Compensation

PMA Companies; United States; Remote; USD 60,000 - 85,000; Full time

Benefits offered by this job

Up to $500 salary boost

Job summary

PMA Companies seeks a Remote Full-time Claims Investigator to independently analyze and resolve complex workers' compensation claims. You will assess coverage, reserves, and settlement options while coordinating with medical and nurse teams to support return-to-work strategies.

The role requires a bachelor’s degree or 4+ years in insurance, 3–5 years of WC claims experience, and an active license in mandated states. Strong organizational and communication skills are essential for success.

Qualifications

• Bachelor's degree, or four+ years of equivalent work experience required in an insurance related industry.
• At least 3-5 years' experience handling lost time workers compensation claims required; past experience with ID jurisdiction is required.
• 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
• Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details
• Strong verbal, written communication skills and customer service skills
• Computer literacy, including working knowledge of MS Office Product Suite
• Ability to travel for business purposes, approximately less than 10%.

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.

Skills

Organizational skills

Critical thinking

Communication skills

Attention to detail

Multi-tasking

Education

Bachelor's degree or 4+ years in insurance

Tools

MS Office

Job description

Remote Full-time

Daily Drop — Subscriber Perk

Reduce Debt

Up to $500 to boost your salary trajectory

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.

Qualifications

• 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 ID jurisdiction is required

• 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

• Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details

• Strong verbal, written communication skills and customer service skills

• Computer literacy, including working knowledge of MS Office Product Suite, i.e. Word, Excel, PowerPoint.

• Ability to travel for business purposes, approximately less than 10%.

We like the way you work it · no gig iddy · Gotta bag it up · no gig iddy ·

We like the way you work it · no gig iddy · Gotta bag it up · no gig iddy ·