- Responsibilities:
- Promptly investigates all assigned claims with minimal supervision, including those of a more complex nature
- Determines coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable)
- Alerts Supervisor and Special Investigations Unit to potentially suspect claims
- Ensures timely denial or payment of benefits in accordance with jurisdictional requirements
- Within granted authority, establishes appropriate reserves with documented rationale, maintains and adjusts reserves over the life of the claim to reflect changes in exposure
- Negotiates claims settlements within granted authority
- Establishes and implements appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition
- Works collaboratively with PMA nurse professionals to develop and execute return to work strategies
- Selects and manages service vendors to achieve appropriate balance between allocated expense and loss outcome
- Maintains a working knowledge of New York jurisdictional requirements and applicable case law for each state serviced
- Demonstrates technical proficiency through timely, consistent execution of best claim practices
- Communicates effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues
- Provides a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account-specific sessions
- Authorizes treatment based on the practiced protocols established by statute or the PMA Managed Care department
- Assists PMA 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.
- Bachelor's degree and/or four or more years of equivalent work experience required in an insurance related industry required
- North Carolina jurisdiction experience
- Associate in Claims (AIC) Designation or similar professional designation desired
- License required or ability to obtain license within 90 days of employment in mandated states
- Familiarity with medical terminology and/or Workers' Compensation
- Working knowledge of Workers Compensation regulations, preferably jurisdiction-specific
- 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 gained through previous work experience
- 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%.
-
Claims Adjuster
2 weeks ago
Insurance Placement Solutions Charlotte, United States Full timeInsurance Placement Solutions has an immediate opening for a Remote Workers Compensation Claims Adjuster with our client. As a member of our client's claims team, utilize your knowledge of workers compensation to independently investigate, evaluate and resolve assigned claims in ...
-
Claims Adjuster Workers Compensation
1 day ago
Gallagherbassett Charlotte, United States** Claims Adjuster Workers Compensation** · **** · New Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through th ...
-
Remote - Claims Adjuster - Automotive/RV
1 day ago
The Reynolds and Reynolds Company Charlotte, United StatesPosition description: · This is a full-time, remote position. · American Guardian Warranty Services, Inc. (AGWS), an affiliate of Reynolds and Reynolds, is seeking Claims Adjuster - Automotive/RV for our growing team. In this role you will work remotely and be responsible for i ...
-
Senior Lost Time Claims Adjuster
6 days ago
PMA Companies Charlotte, United StatesAs 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 manag ...
-
Senior Lost Time Claims Adjuster
3 days ago
PMA Companies Charlotte, United StatesAs 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 manag ...
-
Claims Adjuster Trainee, I, II
4 days ago
National General Insurance Charlotte, United StatesJob Description · ** Ideal candidate will be located in Winston-Salem or Charlotte, NC area. The Trainee role will be an in-office opportunity. ** · Primary Purpose: · Studies and successfully completes the Claims Training Program including but not limited to company orientation ...
-
Claims Adjuster Trainee, I, II
5 days ago
National General Charlotte, United States Full time** Ideal candidate will be located in Winston-Salem or Charlotte, NC area. The Trainee role will be an in-office opportunity. ** · Primary Purpose: · Studies and successfully completes the Claims Training Program including but not limited to company orientation, company prepared ...
-
Property Claims Adjuster
1 week ago
Metro Public Adjustment Rock Hill, SC, United Statesjoin our team Part time or Full time with flexible hours. · Home Inspector, mortgage broker, real estate licensee, appraiser, contractor or related field? Learn to put your skills to work in a different way with paid training. · If you qualify, we will provide training for this l ...
-
Claims Supervisor
1 day ago
Cimarron Insurance Company, Inc. Charlotte, United StatesCLAIMS SUPERVISOR · Cimarron Insurance Company is an admitted property and casualty insurance company in 34 states. Working with independent insurance agents and brokers, Cimarron provides underwriting, risk management, and claims expertise. Cimarron is an active program insurer ...
-
Senior Claims Counsel
1 day ago
DWF Law LLP Charlotte, United StatesDWF Claims Counsel Job Description · DWF is a global company that provides integrated business and legal services. DWF Claims is seeking candidates for General and Professional Liability Claims Specialist positions. This role is responsible for investigating, evaluating and resol ...
-
Claims Supervisor
1 day ago
Cimarron Insurance Company, Inc. Charlotte, United StatesCLAIMS SUPERVISOR · Cimarron Insurance Company is an admitted property and casualty insurance company in 34 states. Working with independent insurance agents and brokers, Cimarron provides underwriting, risk management, and claims expertise. Cimarron is an active program insurer ...
-
Commercial Auto Material Damage
1 day ago
Guideone Mutual Insurance Company Charlotte, United StatesServe as a real partner to our members by processing claims accurately and efficiently so they can resume their life's work without unnecessary delay. If you are optimistic, enjoy helping others in times of need, and are compassionate about making po Adjuster, Damage, Commercial, ...
-
Casualty Adjuster
2 days ago
Ncfbins Charlotte, United States** Come Work With Us** · At NC Farm Bureau, we operate with integrity, employ people who care, and offer benefits that grow with you. Come join the Farm Bureau family. · **Casualty Adjuster** · Location Department Position Reports To Location: Charlotte, NC Department: Claims ...
-
Senior Liability Claims Specialist
2 days ago
CorVel Corporation Charlotte, United States Full timeCorVel is seeking a Senior Liability Claims Specialist. The Senior Liability Claims Specialist manages within company best practices complex and non-complex Auto and General Liability claims. Additionally, the Specialist will work within delegated authority to best possible outco ...
-
Field CAT Adjuster
3 days ago
Chubb Charlotte, United StatesJob Description · Field CAT Property Claim Adjuster · About The Chubb Career Opportunity · We are seeking a highly skilled and motivated Field CAT (Catastrophe) Property Claim Adjuster to join our team. The ideal candidate will have extensive experience in handling property cla ...
-
Senior Casualty Adjuster
4 days ago
Crawford & Company Charlotte, United StatesExcellence In Everything We Touch · Position Summary · Our Casualty Adjuster will work from home to receive assignments · May require travel to service the Charlotte, NC region. · + Eligible for company vehicle, cell phone, and laptop to qualified applicants · Under moderate ...
-
Estimate Reviewer- Quality Review
1 day ago
Alacrity Solutions Charlotte, United StatesAlacrity Solutions · Quality Reviewer · Alacrity Solutions is a full end-to-end provider delivering streamlined insurance claims, repair, and recovery solutions. As one of the largest independent providers of insurance claims services in North America, we provide property, auto, ...
-
Bodily Injury Claims Specialist
4 days ago
Auto-Owners Insurance Charlotte, United StatesA career at Auto-Owners is challenging and rewarding. Our group of caring associates create financial security by helping individuals and businesses make a new start when a loss occurs. · Job Description · Job Description · We offer a merit-based work-from-home program based o ...
-
Legal Assistant
1 day ago
State of North Carolina Charlotte, United States"Anticipated Vacancy" · Salary Recruitment Range: $36,682 - $39,000 · Salary Grade: NC08 · Mission of the Industrial Commission · The North Carolina Industrial Commission is vested as a court of exclusive and original jurisdiction by the General Assembly to adjudicate and adminis ...
-
Workers Comp Claims Supervisor
2 days ago
Selective Insurance Charlotte, United StatesAt Selective, we don't just insure uniquely, we employ uniqueness. · Our Business · Selective is a midsized U.S. domestic property and casualty insurance company with a history of strong, consistent financial performance for nearly 100 years.Selective's unique position as both ...
Lost Time Claims Adjuster II - Charlotte, United States - PMA Companies
Description
As a member of our Claims team, utilize your knowledge of Workers Compensation Claims 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.
