Sr. Claims Representative - Workers Compensation - PMA Companies : Job Details

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 jurisdicti...Workers Compensation, Claims Representative, Claims, Worker, Compensation, Representative, Retail, Insurance