Account Claims Associate

PMA Insurance Group De Witt , NY 13214

Posted 5 months ago

As a member of our Claims team, you will proactively manage medical only and limited lost time claims in order to minimize losses, manage permanent total claims in order to minimize losses, and provide superior customer service.

Responsibilities:

  • Contact accounts on First Notices of Loss to obtain missing information pertinent to file set-up

  • Process payments, answer phone calls, authorize treatment associated with Medical Only claims

  • Complete appropriate contacts within 24 hours of assignment, and establish and maintain appropriate diary for follow-up

  • Determine whether treatment is appropriate and causally related to the compensable injury

  • Redirect treatment to network physicians as appropriate

  • Refer subrogation potential claims or potential permanency claims to Supervisor

  • Work to ensure compliance with all appropriate jurisdictional requirements on Medical Only claims, including timely form filing if applicable

  • Maintain a working knowledge of jurisdictional requirements and obtain/maintain state adjusting licenses

  • Administer benefits on Permanent Total or Death cases, which includes monitoring for changes in life or work status, implied interest in resolution or marked increases in costs.

  • 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.

Requirements:

  • High school diploma or equivalent

  • One or more years of Workers Compensation claims handling experience

  • Active adjusters license required

  • Familiarity with medical terminology

  • Ability to work independently, handle multiple tasks simultaneously, make difficult decisions and focus on details

  • Strong organizational skills

  • Excellent verbal and written communication skills

  • Proficiency MS Excel and MS Word.

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Regional Claims Supervisor Workers Compensation

PMA Insurance Group

Posted 1 week ago

VIEW JOBS 10/8/2019 12:00:00 AM 2020-01-06T00:00 As a member of our Claims management team supervise claims staff to ensure appropriate claim outcomes through consistent execution of best claims practice. In this role utilize your prior claims and management experience to achieve business plan goals and to ensure compliance with legal statutes, policy provisions and company guidelines while fostering a culture of communication. Responsibilities: * Manages the assignment of losses to claims staff and provides technical direction and ongoing guidance through effective diary management. * Ensures timely, accurate documentation of claim activity. * Selects, trains, coaches and mentors unit personnel. * Plans staff responsibilities and directs activities, utilizing staff resources effectively to meet department goals in accordance with approved plans and budgets. * Develops staff to respond to current and anticipated needs of department as well as determining career development goals of individuals. * Ensures appropriate case reserves consistent with company guidelines. * Extends settlement authority on claims exceeding adjuster's granted authority. * Develops, recommends and implements short range objectives consistent with company business goals, guidelines and programs. * Recognizes and analyzes trends across the claims portfolio at the adjuster, unit and account levels. * Reports on observations and recommends remedial action as needed. * Administers salary and personnel programs under guidance of manager. * Utilizes quality assurance programs and develops training agenda based on opportunities for improvement. * Utilizes performance management process effectively, on an ongoing basis, to maximize performance of employees, correct performance problems, provide development opportunities, and promote effective communication with employees. * Manages the account management process and resolves service issues. * Promotes effective communication among and between work groups, and between management and employees. * 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 and/or a minimum of three years of work experience in an insurance related industry required. * Extensive knowledge of WC regulations (jurisdiction-specific), insurance contracts, applicable law and adjusting techniques. * Familiarity with medical terminology. * Demonstrated leadership, coaching, mentoring and teamwork skills * Advanced skills in applying sound judgment/analysis, decision making/problem solving, planning and organization and negotiation. * Excellent verbal and written communication skills. * Excellent customer service and collaboration skills gained through previous work experience. * Computer literacy, including working knowledge of MS Office Product Suite, i.e. Word, Excel, PowerPoint. * Previous supervisory experience, Chartered Property Casualty Insurance (CPCU); * Associate in Claims (AIC) designation or similar professional designation desired. * Ability to travel for business purposes; approximately 15% PMA Insurance Group De Witt NY

Account Claims Associate

PMA Insurance Group