Claims Associate - Medical Only Claims - FL, GA, AL

PMA Insurance Group•Tampa, FL

73d

About The Position

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.

Requirements

High school diploma or equivalent
One or more years of Workers Compensation claims handling experience
License required or ability to obtain license within 90 days of employment in mandated states
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.

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.