PMA Companies

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:
<ul>
<li>Promptly investigate all assigned claims with minimal supervision, including those of a more complex nature</li>
<li>Determine coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable)</li>
<li>Alert Supervisor and Special Investigations Unit to potentially suspect claims</li>
<li>Ensure timely denial or payment of benefits in accordance with jurisdictional requirements</li>
<li>Establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure</li>
<li>Negotiate claims settlements with client approval</li>
<li>Establish and implement appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition</li>
<li>Work collaboratively with Lodestar nurse professionals to develop and execute return to work strategies</li>
<li>Select and manage service vendors to achieve appropriate balance between allocated expense and loss outcome</li>
<li>Maintain a working knowledge of jurisdictional requirements and applicable case law for each state serviced</li>
<li>Demonstrate technical proficiency through timely, consistent execution of best claim practices</li>
<li>Communicate effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues</li>
<li>Provide a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account-specific sessions</li>
<li>Authorize treatment based on the practiced protocols established by statute or the Lodestar Managed Care department</li>
<li>Assist Lodestar clients by suggesting panel provider information in accordance with applicable state statutes.</li>
<li>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.</li>
</ul>
#LI-Remote
Requirements:
Requirements:
<ul>
<li>Remote but must reside in PA, NJ or DE and be available for occasional client meetings in PA</li>
<li>Bachelor's degree, or four or more years of equivalent work experience required in an insurance related industry required</li>
<li>At least 3-5 years' experience handling lost time workers compensation claims required; past experience with PA jurisdiction is required</li>
<li>Associate in Claims (AIC) Designation or similar professional designation desired.</li>
<li>Active license required or ability to obtain license within 90 days of employment in mandated states.</li>
<li>Familiarity with medical terminology and/or Workers' Compensation</li>
<li>Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously</li>
</ul>

Senior Claims Adjuster

Senior Claims Adjuster

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