Senior Lost Time Claims Adjuster - Workers Compensation
Location: Tampa, FL
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.
* 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.
Keywords: claims, adjuster, examiner, specialist, processor, representative, analyst, manager, supervisor, assistant, associate, lost time, medical only, workers compensation, wc
* 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 Georgia, Alabama, and Florida jurisdiction is required
* Associate in Claims (AIC) Designation or similar professional designation desired.
* 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%.
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled