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For your reference, we have included the original job posting below.
Sr. Account Claims Representative-WC
Job Number:
26788270
Company Name:
PMA Capital Corporation
Job Location:
Blue Bell, PA US
Job Category:
Insurance
Sr. Account Claims Representative-WC
Sr. Account Claims Representative-WC
Job Type: Full-Time Location: Blue Bell, PA Last Updated: 08/25/2010
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.
Essential Functions:
* 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.
Qualifications:
* Bachelor's degree and/or four or more years of equivalent work experience required in an insurance related industry required.
* Associate in Claims (AIC) Designation or similar professional designation desired.
* Familiarity with medical terminology and/or Workers' Compensation Working knowledge of Workers Compensation regulations, preferably jurisdiction-specific.
* 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 %.
As a leader in the property and casualty insurance industry with multiple locations, our clients choose PMA Capital Corporation because we understand that excellent service begins with our employees. Our working relationships with clients are marked by professionalism, execution and accountability and our company culture is centered on teamwork. This combination has earned an AM Best A- rating (Excellent) and created a supportive work environment that encourages personal and professional growth.
We offer a very competitive compensation package including two retirement contribution savings plans: a 401(k) with dollar for dollar match on the first 5% of salary and a company funded retirement contribution plan; tuition reimbursement and much more!
