Bilingual Senior Claims Adjuster - Workers Compensation - California Remote
Estimated Pay | $20 per hour |
---|---|
Hours | Full-time, Part-time |
Location | Roseville, California |
Compare Pay
Estimated Pay$15.89
$19.54
$31.29
About this job
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, compatibility, 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.
- Bachelor's degree or equivalent work experience required
- At least 5 years of experience handling lost time workers compensation claims in California, additional jurisdictions a plus
- Active CA adjuster license required, additional states a plus
- SIP Designation preferred
- Bilingual in Spanish preferred
- 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
- Computer literacy, including working knowledge of MS Office Product Suite, i.e. Word, Excel, PowerPoint
Compensation:
PMA is providing applicants with the anticipated wage range for this position in compliance with state regulations. The wage range for the Senior Claims Adjuster role is $75,900 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.