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:
- 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 CA 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.
#LI-Remote
Preferred QualificationsRequirements:
- Must possess CA License and experience
- Bachelor's degree and/or four or more years of equivalent work experience required in an insurance related industry required
- SIP certification preferred, ability to obtain required
- 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
- 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
Compensation:
PMA is providing applicants with the anticipated wage range for this position in compliance with state regulations. The wage range for this role is $71,300 to $82,600. Wage ranges are based on national market data and may cover a wide range of geographies. Applicants may be paid above, within or below this range based on a variety of factors.
PMA Companies Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about PMA Companies and has not been reviewed or approved by PMA Companies.
-
Leave & Time Off Breadth — Time off is described as generous, with a sizable PTO bank and a broad paid-holiday schedule. Feedback suggests the ability to accrue and use substantial leave is a standout element of the package.
-
Retirement Support — Retirement support includes a 401(k) with company contributions and immediate vesting on certain employer dollars. Profit-sharing and automatic eligibility are positioned as meaningful additions to total rewards.
-
Flexible Benefits — Benefits are organized in a cafeteria-style format with multiple medical plan choices, HSA options, FSAs, and a broad set of voluntary coverages. Feedback suggests this flexibility enables tailoring coverage to individual needs.
PMA Companies Insights
Similar Jobs
What We Do
PMA Companies provides risk management solutions and services, specializing in workers’ compensation and offering property & casualty insurance, in the United States. Headquartered in Blue Bell, PA, PMA Companies is a member of Old Republic Companies. Old Republic International Corporation (NYSE: ORI) is one of the nation’s 50 largest publicly held insurance organizations. PMA Companies includes: PMA Insurance Group, specializing in workers’ compensation, and providing other commercial property & casualty insurance products; and PMA Management Corp. and PMA Management Corp. of New England, providing results-driven TPA and Risk Services specializing in workers’ compensation and liability. We maintain a large client retention rate of 90% or higher and a client satisfaction rate of 96% per an independent survey. At PMA, we still build relationships the "old-fashioned way." Our clients know we care. They know we say what we do and do what we say. And they know that they can count on us to deliver tangible value to their business and to work passionately on their behalf.
