<strong>Job Description<br><br></strong>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.<br><br><strong>Responsibilities<br><br></strong><ul><li>Promptly investigates all assigned claims with minimal supervision, including those of a more complex nature</li><li>Determines coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable)</li><li>Alerts Supervisor and Special Investigations Unit to potentially suspect claims</li><li>Ensures timely denial or payment of benefits in accordance with jurisdictional requirements</li><li>Within granted authority, establishes appropriate reserves with documented rationale, maintains and adjusts reserves over the life of the claim to reflect changes in exposure</li><li>Negotiates claims settlements within granted authority</li><li>Establishes and implements appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition</li><li>Works collaboratively with PMA nurse professionals to develop and execute return to work strategies</li><li>Selects and manages service vendors to achieve appropriate balance between allocated expense and loss outcome</li><li>Maintains a working knowledge of New York jurisdictional requirements and applicable case law for each state serviced</li><li>Demonstrates technical proficiency through timely, consistent execution of best claim practices</li><li>Communicates effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues</li><li>Provides 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>Authorizes treatment based on the practiced protocols established by statute or the PMA Managed Care department</li><li>Assists PMA 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.<br><br></li></ul><strong>Requirements<br><br></strong><strong>Requirements:<br><br></strong><ul><li>Bachelor's degree and/or four or more years of equivalent work experience required in an insurance related industry required</li><li>MI jurisdiction experience</li><li>Associate in Claims (AIC) Designation or similar professional designation desired</li><li>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>Working knowledge of Workers Compensation regulations, preferably jurisdiction-specific</li><li>Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously</li><li>Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details</li><li>Strong verbal, written communication skills and customer service skills gained through previous work experience</li><li>Computer literacy, including working knowledge of MS Office Product Suite, i.e. Word, Excel, PowerPoint</li><li>Ability to travel for business purposes, approximately less than 10%.</li></ul>