PMA Companies
Sr. Claims Representative - Workers Compensation - California
PMA Companies, Fresno, California, United States, 93650
Sr. Claims Representative - Workers Compensation - California
Join our claims team as a
Sr. Claims Representative - Workers Compensation - California
at
PMA Companies . Utilize your Workers Compensation knowledge to investigate, evaluate, and resolve complex claims independently, ensuring appropriate outcomes. You will handle high-risk management claims promptly, in accordance with legal statutes, policy provisions, and company guidelines. Responsibilities
Investigate assigned claims promptly with minimal supervision, including complex cases 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 per jurisdictional requirements Establish and adjust reserves with documented rationale throughout the claim's lifecycle Negotiate claims settlements with client approval Develop and implement case resolution action plans, including medical/disability management, litigation, negotiation, and disposition Collaborate with PMA nurse professionals on return-to-work strategies Select and manage service vendors balancing expenses and loss outcomes Maintain knowledge of jurisdictional requirements and case law for serviced states Execute claim practices proficiently and consistently Communicate effectively with internal and external parties Provide high-quality customer service during claims reviews and meetings Authorize treatment based on established protocols Assist clients with panel provider information as per state statutes Adhere to Companys Code of Business Conduct and Ethics, ensuring compliance with relevant policies and laws Requirements
Bachelor's degree or 4+ years of equivalent insurance industry experience 3-5 years of experience handling lost time workers' compensation claims, with California jurisdiction experience required Associate in Claims (AIC) or similar designation preferred Active license or ability to obtain within 90 days in mandated states Knowledge of medical terminology and Workers' Compensation Strong organizational skills and ability to work independently Critical thinking and sound judgment skills Excellent verbal, written communication, and customer service skills Proficiency in MS Office Suite (Word, Excel, PowerPoint) Ability to travel less than 10% for business The anticipated wage range is $82,200 to $95,900, based on market data and geographic factors. Compensation may vary based on experience and other factors. Additional Details
Seniority level: Mid-Senior level Employment type: Full-time Job function: Finance and Sales Industry: Insurance Referrals can increase your chances of interview opportunities. Sign in to set job alerts for "Senior Claims Representative" roles. #J-18808-Ljbffr
Join our claims team as a
Sr. Claims Representative - Workers Compensation - California
at
PMA Companies . Utilize your Workers Compensation knowledge to investigate, evaluate, and resolve complex claims independently, ensuring appropriate outcomes. You will handle high-risk management claims promptly, in accordance with legal statutes, policy provisions, and company guidelines. Responsibilities
Investigate assigned claims promptly with minimal supervision, including complex cases 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 per jurisdictional requirements Establish and adjust reserves with documented rationale throughout the claim's lifecycle Negotiate claims settlements with client approval Develop and implement case resolution action plans, including medical/disability management, litigation, negotiation, and disposition Collaborate with PMA nurse professionals on return-to-work strategies Select and manage service vendors balancing expenses and loss outcomes Maintain knowledge of jurisdictional requirements and case law for serviced states Execute claim practices proficiently and consistently Communicate effectively with internal and external parties Provide high-quality customer service during claims reviews and meetings Authorize treatment based on established protocols Assist clients with panel provider information as per state statutes Adhere to Companys Code of Business Conduct and Ethics, ensuring compliance with relevant policies and laws Requirements
Bachelor's degree or 4+ years of equivalent insurance industry experience 3-5 years of experience handling lost time workers' compensation claims, with California jurisdiction experience required Associate in Claims (AIC) or similar designation preferred Active license or ability to obtain within 90 days in mandated states Knowledge of medical terminology and Workers' Compensation Strong organizational skills and ability to work independently Critical thinking and sound judgment skills Excellent verbal, written communication, and customer service skills Proficiency in MS Office Suite (Word, Excel, PowerPoint) Ability to travel less than 10% for business The anticipated wage range is $82,200 to $95,900, based on market data and geographic factors. Compensation may vary based on experience and other factors. Additional Details
Seniority level: Mid-Senior level Employment type: Full-time Job function: Finance and Sales Industry: Insurance Referrals can increase your chances of interview opportunities. Sign in to set job alerts for "Senior Claims Representative" roles. #J-18808-Ljbffr