- 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 North Carolina 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%.
-
Claims adjuster
1 week ago
Randstad Charlotte, United StatesAre you passionate about facilitating seamless transitions and ensuring customer satisfaction? Join our team as a Change of Ownership Associate and become an integral part of our operations. You will be able to provide clients with a seamless transition process when their life ev ...
-
Mechanical Claims Adjuster
4 days ago
Hendrick Autoguard Inc. Charlotte, United StatesJob Description · Job DescriptionResponsibilities: · • Analyze, review, and interpret policies to assess coverage and liability. · Verify repair information to determine if coverage is within the guidelines of the service contract. · • Establish and maintain proper loss and expen ...
-
Claims Adjuster I or II
3 weeks ago
National General Insurance Charlotte, United StatesJob Description · **The Claims Adjuster role is available at either our Winston Salem or Charlotte, NC office locations. If you are ready to continue growing your career and utilize your experience as an adjuster. Apply with us today ** · Job Summary: · The Claims Inside Auto An ...
-
Claims Adjuster Workers Compensation
1 week 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
6 days 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 ...
-
Claims Adjuster Trainee, I, II, or Sr
3 days ago
Allstate Insurance Company Charlotte, United StatesJob Description · ** Ideal candidate will be located in the Winston-Salem and Charlotte, NC area. The Trainee role will be an in-office position. ** · Job Summary: · The Claims Inside Auto Trainee Analyst II is responsible for investigating and confirming the facts of loss for ...
-
Sr. Workers Compensation Claims Adjuster
2 weeks ago
Insurance Relief Charlotte, United StatesSr. Workers Compensation Claims Adjuster - Remote - Sacramento, CA · *Candidates must reside in California* · Are you seeking a career where you can better assist people and help support a strong team? A well-established TPA needs your help to support its ambitious team. Join a ...
-
Senior Workers Compensation Claims Adjuster
3 weeks ago
Gallagher Charlotte, United StatesAbout Us: · Join our growing team of dedicated professionals at Gallagher Bassett, who guide those in need to the best possible outcomes for their health and wellbeing. You'll be part of a resilient team that works together to redefine the boundaries of excellence. At our organi ...
-
Senior Casualty Adjuster
3 weeks ago
Crawford & Company Charlotte, United States Regular Full timePosition 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 to light supervision, investigates, r ...
-
020 Travelers Indemnity Co Charlotte, United States Full timeWho Are We? · Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a cultu ...
-
Personal Injury Paralegal
3 hours ago
Jones Networking Charlotte, United StatesPersonal Injury Paralegal (Hybrid) · Charlotte, North Carolina · Jones Networking is recruiting for a Paralegal to join a Personal Injury Law Firm in Charlotte, NC. Our client offers a competitive salary, excellent benefits, PTO and 401K. · Position Summary for the Personal Inju ...
-
Professional Review Specialist I
3 weeks ago
CorVel Corporation Charlotte, United States Full timeThe Professional Review Specialist provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills to determine appropriateness of medical care. · Candidates must be located in the greater Charlotte, NC region and able to attend i ...
-
System Specialist
3 weeks ago
Safe Foods Charlotte, United StatesWHO YOU ARE: · Are you a hands-on problem solver with a passion for cutting-edge technology? We are in search of a dedicated System Specialist to join our talented team. As a System Specialist you will be the face of our organization, providing exceptional on-site support to our ...
-
VP, Environmental Health
3 weeks ago
Carolina CAT Charlotte, United StatesSummary · Weisiger Group is looking for a Vice President of Environmental Health and Safety (EHS) to plan, implement, manage, and direct EHS strategies, policies, programs, and processes to ensure a positive safety culture that is in compliance with all applicable regulations an ...
-
Casualty Adjuster
1 week 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 ...
-
P&C TPA Oversight Claims Specialist
6 days ago
KING'S INSURANCE STAFFING LLC Charlotte, United StatesOur client, a National Insurance Carrier, is seeking to add a P&C Oversight Claims Specialist to North Carolina operations. This person would be responsible for overseeing Commercial/Personal Auto, General Liability, Property, and Bodily Injury claims being handled by TPA's. This ...
-
Flood Field Adjuster
2 days ago
Alacrity Solutions Charlotte, United StatesJob Description · Job DescriptionAlacrity Solutions · Independent Contractor · Flood Field Adjuster · About Alacrity Solutions · Alacrity Solutions is a full end-to-end provider delivering streamlined insurance claims, repair, and recovery solutions. As one of the largest indepen ...
-
Senior Claims Counsel
3 weeks ago
DWF Law LLP Charlotte, United StatesDWF teams in the USA are at the heart of our Insurance Services and Legal Operations offering. · Our Insurance Services Claims team combine technical excellence and superior service across the whole lifecycle of a claim. Our centralized approach generates greater efficiencies and ...
-
CorVel Enterprise Comp, Inc. Charlotte, United StatesJob Description · Job DescriptionCorVel is seeking a Senior Auto and General Liability Claims Specialist. This role manages, within company best practices, complex and non-complex Auto and General Liability claims. Additionally, the Specialist will work within delegated authority ...
-
Public Adjuster Estimator
1 week ago
KBM Charlotte, United StatesJob Description · Job DescriptionAre you looking to start a new and exciting career? We offer great training, a competitive salary, and great bonuses when goals are met. We will support you while you obtain your public adjusting license by paying for your required course and stat ...
Lost Time Claims Adjuster I - Charlotte, United States - PMA Companies
![Default job background](https://contents.bebee.com/public/img/bg-user-ex-1.jpg)
Description
Job 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: