Senior Account Claims Representative - Workers Compensation
Company: PMA Insurance Group
Location: White Plains
Posted on: June 7, 2021
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
- Promptly investigate all assigned claims with minimal
supervision, including those of a more complex nature
- Determine coverage, compensability, potential for subrogation
recovery, and second injury fund (when applicable)
- Alert Supervisor and Special Investigations Unit to potentially
- Ensure timely denial or payment of benefits in accordance with
- Establish appropriate reserves with documented rationale,
maintain and adjust reserves over the life of the claim to reflect
changes in exposure
- Negotiate claims settlements with client approval
- Establish and implement appropriate action plans for case
resolution including medical and disability management, litigation
management, negotiation and disposition
- Work collaboratively with PMA nurse professionals to develop
and execute return to work strategies
- Select and manage service vendors to achieve appropriate
balance between allocated expense and loss outcome
- Maintain a working knowledge of jurisdictional requirements and
applicable case law for each state serviced
- Demonstrate technical proficiency through timely, consistent
execution of best claim practices
- Communicate effectively, verbally and in writing with internal
and external parties on a wide variety of claims and account
- Provide 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 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.
- Bachelor's degree, or equivalent work experience.
- At least 3-5 years experience handling lost time workers'
compensation claims in NY is required.
- Experience working with unbundled claims preferred.
- Associate in Claims (AIC) Designation or similar professional
- Familiarity with medical terminology and/or Workers'
- Strong organizational skills with demonstrated ability to work
independently and deal effectively with multiple tasks
- Proven critical thinking skills that demonstrate
analysis/judgment and sound decision making with focus on attention
- Strong verbal, written communication skills and customer
- Computer literacy, including working knowledge of MS Office
Product Suite, i.e. Word, Excel, PowerPoint.
- Ability to travel for business purposes, approximately less
Keywords: PMA Insurance Group, White Plains , Senior Account Claims Representative - Workers Compensation, Other , White Plains, New York
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