Senior Workers Compensation Claims Adjuster - Roseville, CA

Company: PMA Companies
Location: Roseville
Posted on: January 15, 2025

Job Description:

Back Senior Workers Compensation Claims Adjuster #4324 Multiple Locations Apply Apply for this job now! Apply Job Description:
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 company guidelines.

Responsibilities:

• 
  
• 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 suspect claims
  
• Ensure timely denial or payment of benefits in accordance with jurisdictional requirements
  
• 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 issues
  
• 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.
  
  #LI_Remote
  Requirements:
  • 
    
  • Bachelor's degree, or four or more years of equivalent work experience required in an insurance related industry required
    
  • At least 3-5 years' experience handling lost time workers compensation claims required; past experience with CA jurisdiction is required
    
  • CA License required
    
  • Associate in Claims (AIC) Designation or similar professional designation desired.
    
  • Active license required or ability to obtain license within 90 days of employment in mandated states.
    
  • Familiarity with medical terminology and/or Workers' Compensation
    
  • 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
    
  • 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%.
    
    
    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 $78,500 to $97,200. 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.
    
    
    

Keywords: PMA Companies, Yuba City , Senior Workers Compensation Claims Adjuster - Roseville, CA, Other , Roseville, California