- 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 PMA 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 PMA Managed Care department
- Assist 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, 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 MA, CT, VT and RI jurisdictions required.
- CT license required.
- Associate in Claims (AIC) Designation or similar professional designation desired.
- 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%.
-
Senior Claims Adjuster
5 days ago
PMA Companies Boston, United StatesJob Description: · 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 resolv ...
-
Auto Claims Adjuster Trainee
4 days ago
Safety Insurance Group, Inc. Boston, United StatesJob Details · Level: Entry · Job Location: Safety Insurance Main Office - Boston, MA · Position Type: Full Time · Education Level: Bachelor's Degree · Salary Range: Undisclosed · Travel Percentage: None · Job Shift: Day · Job Category: Insurance · Benefits of Working for ...
-
CAT/IA Property Claims Desk Adjuster
2 days ago
American Family Insurance South Boston, United StatesInvestigate and maintain property claims. Review and determine coverage, secures information, evaluates and writes estimates, arranges inspections and appraisals, communicates with insureds and other parties involved, and settles claims.Position Compensation Range: · $55, $90,000 ...
-
RCIS Crop Claims Field Adjuster I
4 days ago
Zurich NA Boston, United StatesRCIS Crop Claims Field Adjuster I · 112138 · Zurich is currently looking for a RCIS Crop Claims Field Adjuster I to join our Rural Community Insurance Services (RCIS) team. RCIS is one of the leading crop insurance providers in the U.S. RCIS offers insurance protection in all 5 ...
-
Senior Property Claims Examiner
1 week ago
Massachusetts Property Insurance Underwriting Association Boston, United StatesMassachusetts Property Insurance Underwriting Association is seeking a Senior Claims Examiner to join our Claims Department. · This position is responsible for the examination of property claims in accordance with Association claims procedure, and the evaluation and pursuit of sa ...
-
Senior Property Claims Examiner
5 days ago
Massachusetts Property Insurance Underwriting Association Boston, United StatesMassachusetts Property Insurance Underwriting Association is seeking a Senior Claims Examiner to join our Claims Department. · This position is responsible for the examination of property claims in accordance with Association claims procedure, and the evaluation and pursuit of sa ...
-
Property Claims Examiner
2 weeks ago
Massachusetts Property Insurance Underwriting Association Boston, United StatesMassachusetts Property Insurance Underwriting Association is seeking a Claims Examiner to join our Claims Department. · This position is responsible for the examination of property claims in accordance with Association claims procedure, and the evaluation and pursuit of salvage a ...
-
Senior Property Claims Examiner
5 days ago
Massachusetts FAIR Plan Boston, United StatesMassachusetts Property Insurance Underwriting Association is seeking a Senior Claims Examiner to join our Claims Department. · This position is responsible for the examination of property claims in accordance with Association claims procedure, and the evaluation and pursuit of s ...
-
Plymouth Rock Assurance Boston, United StatesThe Plymouth Rock Home team is an innovative Insurtech start-up within a successful, well-established insurance organization. We tripled topline revenue over the past 4 years by revolutionizing the way homeowners insurance is priced, marketed, bought, and sold. Our customers obta ...
-
Total Loss Claims Supervisor
1 week ago
The Jonus Group Boston, United StatesCompensation · Job Description $100,000 - $110,000/year+(based on experience) · 10% annual bonus · 401(k) with company match · Full medical benefits · Requirements · Bachelors Degree or related experience · 5+ years of experience handling Personal Auto/Total Loss Claims · ...
-
Bodily Injury, Claims Representative
2 weeks ago
Plymouth Rock Assurance Boston, United StatesOverview: · Claims Representative, Bodily Injury · Join Our Dynamic Claims Team at Plymouth Rock Assurance · Are you an experienced professional in auto claims handling with a focus on bodily injury losses? Plymouth Rock Assurance is seeking a dedicated individual to fill the ...
-
General Adjuster
2 weeks ago
Engle Martin & Associates Boston, United StatesJob Description · Engle Martin is a leading national independent loss adjusting and claims management provider. We provide a comprehensive line of service offerings including commercial property, casualty, inland marine/cargo, heavy equipment and large loss adjusting, as well as ...
-
Billing Coordinator
2 weeks ago
Tufts University Boston, United StatesOverview · Tufts University School of Dental Medicine (TUSDM) offers one of the most forward-looking educational environments in dental medicine in the country. Revenue Cycle Operations (RCO) supports patient care services revenue cycle management, along with other members of the ...
-
Regional Claims Supervisor
2 weeks ago
PMA Companies Boston, United StatesAs a member of our Claims management team supervise claims staff to ensure appropriate claim outcomes through consistent execution of best claims practice. In this role utilize your prior claims and management experience to achieve business plan goals and to ensure compliance wit ...
-
Claims Supervisor, Total Loss
1 week ago
Plymouth Rock Assurance Boston, United StatesClaims Supervisor, Total Loss · We are excited to announce an opportunity for the position of Auto Total Loss Claims Supervisor in our Boston, MA office. We are seeking a qualified individual to oversee the operations of our unit of Claim Representatives who handle Total Loss Cl ...
-
Content Claims Specialist
2 weeks ago
Crawford & Company Boston, United StatesExcellence In Everything We Touch · Position Summary · The role of Content Claims Specialists is a multi-faceted role, which focuses primarily in the following four key areas of edjusters content claims handling operations: · + Acting/operating as a third party, intermediary b ...
-
Content Claims Specialist
16 hours ago
Crawford & Company Boston, United StatesExcellence In Everything We Touch · Position Summary · The role of Content Claims Specialists is a multi-faceted role, which focuses primarily in the following four key areas of edjusters content claims handling operations: · + Acting/operating as a third party, intermediary b ...
-
Content Claims Specialist
2 days ago
Crawford & Company Boston, United StatesExcellence In Everything We Touch · Position Summary · The role of Content Claims Specialists is a multi-faceted role, which focuses primarily in the following four key areas of edjusters content claims handling operations: · + · Acting/operating as a third party, intermediar ...
-
Claims Specialist
2 weeks ago
Liberty Mutual Insurance Boston, United StatesSchedule: Full-Time Salary Range: USD $ $ Job Category: Claims Pay Philosophy The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects th ...
-
Liberty Mutual Boston, United StatesPay PhilosophyThe typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these posi ...
Senior Claims Adjuster - Boston, United States - PMA Companies
Description
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:
