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    Lost Time Claims Adjuster - Tampa, United States - PMA Companies

    PMA Companies
    PMA Companies Tampa, United States

    3 days ago

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    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.

    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 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
    • Working knowledge of Workers Compensation regulations for Florida jurisdiction.
    • 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
    • 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%.
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