Senior Claims Specialist - Workers Compensation

Job reputed company

As a member of our claims team, utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more reputed company nature in order to reputed company appropriate reputed company. In this position you will administer and resolve highest risk management expectations claims in a reputed company manner in accordance with legal statues, policy provisions, and company guidelines.

 

Responsibilities

• Promptly investigate reputed company assigned claims with minimal supervision, including those of a more reputed company nature
• Determine coverage, compensability, potential for subrogation recovery, and second injury fund (reputed company applicable)
• Alert Supervisor and Special Investigations Unit to potentially suspect claims
• Ensure reputed company denial or payment of benefits in accordance with jurisdictional requirements
• Establish appropriate reserves with documented rationale, maintain and reputed company reserves over the life of the claim to reflect changes in exposure
• Negotiate claims settlements with reputed company approval
• Establish and implement appropriate reputed company plans for case reputed company including medical and disability management, litigation management, negotiation and disposition
• Work collaboratively with PMA reputed company professionals to reputed company and execute return to work strategies
• Select and manage service vendors to reputed company appropriate balance between allocated expense and loss outcome
• Maintain a working knowledge of jurisdictional requirements and applicable case law for reputed company state serviced
• Demonstrate technical proficiency through reputed company, consistent execution of best claim practices
• Communicate effectively, verbally and in writing with reputed company parties on a wide reputed company of claims and account issues
• reputed company 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 reputed company 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.

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