Sr. Corporate Claims Specialist

PMA Companies; Whitpain Township (Montgomery County); On-site; USD 80,000 - 110,000; Full time

Job summary

A leading company in the insurance industry seeks a Technical Claims Supervisor to provide oversight and enforce compliance for complex claims handling. The role involves coaching staff, managing unbundled claims, ensuring adherence to corporate standards, and requires a Bachelor's degree or substantial experience in the field. This position may require travel and emphasizes strong leadership and analytical skills.

Qualifications

• 5+ years of experience in an insurance-related industry required.
• Extensive knowledge of insurance contracts and adjusting techniques.
• Willingness to travel approximately 25%.

Responsibilities

• Provide technical oversight for unbundled claims assigned to TPA partners.
• Assess staff training needs and conduct training focused on improving performance.
• Lead project teams focused on resolving corporate claims issues.

Skills

Leadership

Coaching

Negotiation

Decision Making

Customer Service

Teamwork

Communication

Education

Bachelor's degree or equivalent work experience

Tools

MS Office Suite

Job description

Description

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.
• Willingness to travel for business purposes. Travel approximately 25%.
• Obtains and maintains state adjusting licenses, as necessary. Ensures that all state-required Continuing Education Credits are obtained as needed to maintain license.