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Claims Adjusters & Senior Claims Adjusters – Workers Compensation

PMA Companies

This is a Full-time position in Anaheim, CA posted February 18, 2021.

PMA Companies is growing our Workers Compensation Claims team in California.

We are seeking talented Claims Adjusters and Senior Claims Adjusters in both Northern and Southern California.

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 New York 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.Job Requirements:Bachelor’s degree orequivalent work experience.Minimum of 3-7 years of lost time workers compensation experience.California jurisdictional experience required, additional states a plus.The ideal candidate should either possess (or quickly obtain) qualified manager status for unbundled workers compensation and PAL claims, as well as possess (or quickly obtain) a certificate to administer for the adjustment of self-insured workers compensation claims.Associate in Claims (AIC) Designation or similar professional designation desired.Familiarity with medical terminology.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 and Powerpoint.Ability to travel for business purposes, approximately less than 10%.

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