PMA Companies
Sr. Claims Representative - Workers Compensation - California
PMA Companies, Redding, California, United States, 96001
Sr. Claims Representative - Workers Compensation - California
Join our claims team at
PMA Companies
as a
Sr. Claims Representative - Workers Compensation - California . Utilize your Workers Compensation knowledge to investigate, evaluate, and resolve complex claims independently. Administer and resolve high-risk claims promptly, in accordance with legal statutes, policy provisions, and company guidelines. Responsibilities
Investigate assigned claims promptly, including complex cases Determine coverage, compensability, subrogation potential, and second injury fund eligibility Alert supervisors and investigative units to suspicious claims Ensure timely benefits denial or payment as per jurisdictional requirements Establish and adjust reserves with documented rationale throughout the claim lifecycle Negotiate settlements with client approval Develop case resolution strategies, including medical, disability, litigation management, and negotiation Collaborate with PMA nurses on return-to-work strategies Manage service vendors to balance expenses and loss outcomes Maintain knowledge of jurisdictional requirements and case law Execute claim practices proficiently and consistently Communicate effectively with internal and external parties Provide high-quality customer service during claims reviews and meetings Authorize treatments per statutes or PMA Managed Care protocols Assist clients with panel provider suggestions as per state laws Adhere to the company's Code of Business Conduct and Ethics, ensuring compliance with applicable laws and policies Requirements
Bachelor's degree or 4+ years of relevant insurance industry experience 3-5 years of experience handling workers compensation claims, specifically in California Desired: Associate in Claims (AIC) or similar designation Active license or ability to obtain within 90 days in mandated states Knowledge of medical terminology and Workers' Compensation Strong organizational and multitasking skills Critical thinking, sound judgment, and attention to detail Excellent communication and customer service skills Proficiency in MS Office Suite Willingness to travel less than 10% for business The salary range for this position is $82,200 to $95,900, based on market data and geographic factors. Additional Details
Seniority level: Mid-Senior level Employment type: Full-time Job function: Finance and Sales Industry: Insurance Referrals can double your chances of interview success. Get notified about new jobs in Redding, CA. #J-18808-Ljbffr
Join our claims team at
PMA Companies
as a
Sr. Claims Representative - Workers Compensation - California . Utilize your Workers Compensation knowledge to investigate, evaluate, and resolve complex claims independently. Administer and resolve high-risk claims promptly, in accordance with legal statutes, policy provisions, and company guidelines. Responsibilities
Investigate assigned claims promptly, including complex cases Determine coverage, compensability, subrogation potential, and second injury fund eligibility Alert supervisors and investigative units to suspicious claims Ensure timely benefits denial or payment as per jurisdictional requirements Establish and adjust reserves with documented rationale throughout the claim lifecycle Negotiate settlements with client approval Develop case resolution strategies, including medical, disability, litigation management, and negotiation Collaborate with PMA nurses on return-to-work strategies Manage service vendors to balance expenses and loss outcomes Maintain knowledge of jurisdictional requirements and case law Execute claim practices proficiently and consistently Communicate effectively with internal and external parties Provide high-quality customer service during claims reviews and meetings Authorize treatments per statutes or PMA Managed Care protocols Assist clients with panel provider suggestions as per state laws Adhere to the company's Code of Business Conduct and Ethics, ensuring compliance with applicable laws and policies Requirements
Bachelor's degree or 4+ years of relevant insurance industry experience 3-5 years of experience handling workers compensation claims, specifically in California Desired: Associate in Claims (AIC) or similar designation Active license or ability to obtain within 90 days in mandated states Knowledge of medical terminology and Workers' Compensation Strong organizational and multitasking skills Critical thinking, sound judgment, and attention to detail Excellent communication and customer service skills Proficiency in MS Office Suite Willingness to travel less than 10% for business The salary range for this position is $82,200 to $95,900, based on market data and geographic factors. Additional Details
Seniority level: Mid-Senior level Employment type: Full-time Job function: Finance and Sales Industry: Insurance Referrals can double your chances of interview success. Get notified about new jobs in Redding, CA. #J-18808-Ljbffr