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Career Opportunities |
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Posted: 6/1/2010 |
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PMA Management Corp of N.E. Harrison, New York |
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Account Claim Representative
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As a member of PMA Management Corp of N.E. Harrison, New York Claims team, utilize your knowledge of Workers Compensation Claims to independently investigate, evaluate and resolve assigned claims to achieve appropriate outcomes. In this position you will administer and resolve assigned claims in a timely manner in accordance with legal statues, policy provisions, and company guidelines.
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Promptly investigates all assigned claims with minimal supervision.
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Determines coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable). |
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Alerts Supervisor and Special Investigations Unit to potentially suspect claims. |
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Ensures timely denial or payment of benefits in accordance with jurisdictional requirements. |
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Within granted authority, establishes appropriate reserves with documented rationale, maintains and adjusts reserves over the life of the claim to reflect changes in exposure. |
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Negotiates claims settlements within granted authority. |
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Establishes and implements appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition. |
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Works collaboratively with PMA nurse professionals to develop and execute return to work strategies. |
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Selects and manages service vendors to achieve appropriate balance between allocated expense and loss outcome. |
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Maintains a working knowledge of jurisdictional requirements and applicable case law for each state serviced. |
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Demonstrates technical proficiency through timely, consistent execution of best claim practices. |
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Communicates effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues. |
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Provides a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account-specific sessions. |
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Authorizes treatment based on the practiced protocols established by statute or the PMA Managed Care department. |
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Assists PMA clients by suggesting panel provider information in accordance with applicable state statutes. |
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Bachelor's degree and/or four or more years of equivalent work experience required in an insurance related industry required.
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Associate in Claims (AIC) Designation or similar professional designation desired. |
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Familiarity with medical terminology and/or Workers' Compensation |
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Working knowledge of Connecticut Compensation regulations |
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Working knowledge of other New England State regulations a plus |
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Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously |
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Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details |
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Strong verbal, written communication skills and customer service skills gained through previous work experience. |
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Computer literacy, including working knowledge of MS Office Product Suite, i.e. WORD, Excel, PowerPoint. |
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Ability to travel for business purposes, approximately less than 10 % |
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As a leader in the property and casualty insurance industry with multiple locations, our clients choose PMA Capital Corporation because we understand that excellent service begins with our employees. Our working relationships with clients are marked by professionalism, execution and accountability and our company culture is centered on teamwork. This combination has earned an AM Best A- rating (Excellent) and created a supportive work environment that encourages
personal and professional growth. To apply directly go to: www.pmagroup.com and click on the career link.
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We offer a very competitive compensation package including two retirement contribution savings plans: a 401(k) with dollar for dollar match on the first 5% of salary and a company funded retirement contribution plan; tuition reimbursement and
much more! |
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PMA Management Corp of N.E. Meriden, CT |
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Account Claim Representative
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As a member of PMA Management Corp of N.E. Meriden, CT Claims team, utilize your knowledge of Workers Compensation Claims to independently investigate, evaluate and resolve assigned claims to achieve appropriate outcomes. In this position you will administer and resolve assigned claims in a timely manner in accordance with legal statues, policy provisions, and company guidelines
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Promptly investigates all assigned claims with minimal supervision.
|
• |
Determines coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable). |
• |
Alerts Supervisor and Special Investigations Unit to potentially suspect claims. |
• |
Ensures timely denial or payment of benefits in accordance with jurisdictional requirements. |
• |
Within granted authority, establishes appropriate reserves with documented rationale, maintains and adjusts reserves over the life of the claim to reflect changes in exposure. |
• |
Negotiates claims settlements within granted authority. |
• |
Establishes and implements appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition. |
• |
Works collaboratively with PMA nurse professionals to develop and execute return to work strategies. |
• |
Selects and manages service vendors to achieve appropriate balance between allocated expense and loss outcome. |
• |
Maintains a working knowledge of jurisdictional requirements and applicable case law for each state serviced. |
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Demonstrates technical proficiency through timely, consistent execution of best claim practices. |
• |
Communicates effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues. |
• |
Provides a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account-specific sessions. |
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Authorizes treatment based on the practiced protocols established by statute or the PMA Managed Care department. |
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Assists PMA clients by suggesting panel provider information in accordance with applicable state statutes. |
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Bachelor's degree and/or four or more years of equivalent work experience required in an insurance related industry required.
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Associate in Claims (AIC) Designation or similar professional designation desired. |
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Familiarity with medical terminology and/or Workers' Compensation |
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Working knowledge of Connecticut Compensation regulations |
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Working knowledge of other New England State regulations a plus |
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Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously |
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Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details |
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Strong verbal, written communication skills and customer service skills gained through previous work experience. |
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Computer literacy, including working knowledge of MS Office Product Suite, i.e. WORD, Excel, PowerPoint. |
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Ability to travel for business purposes, approximately less than 10 % |
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As a leader in the property and casualty insurance industry with multiple locations, our clients choose PMA Capital Corporation because we understand that excellent service begins with our employees. Our working relationships with clients are marked by professionalism, execution and accountability and our company culture is centered on teamwork. This combination has earned an AM Best A- rating (Excellent) and created a supportive work environment that encourages personal and professional growth. To apply directly go to: www.pmagroup.com and click on the career link.
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We offer a very competitive compensation package including two retirement contribution savings plans: a 401(k) with dollar for dollar match on the first 5% of salary and a company funded retirement contribution plan; tuition reimbursement and much more!
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Posted: 5/11/2010 |
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Empire Stat™ |
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Workers’ Compensation Paralegal |
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Empire Stat, one of the nation’s oldest and most respected administrators of the Independent Medical Evaluation process, seeks experienced workers’ compensation paralegal.
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Qualified candidates should possess: |
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7 - 8 years of experience in workers’ compensation |
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Detailed knowledge of the State of New York Workers’ Compensation Board Medical Guidelines |
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Computer proficiency |
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Exceptional oral and written communication skills |
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Ability to train MD’s in the proper usage of the Medical Guidelines. |
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Excellent Compensation and benefits commensurate with experience.
Please fax or email resume to: |
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Tom Dooley
Empire Stat
Email: tom.dooley@empirestat.com
Fax: (212) 279-0225 |
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Posted: 4/19/2010 |
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| Alliance Worldwide Investigative Group, Inc., a regional investigative firm with an expanding presence in the northeast is seeking an experienced Account Executive to assist in the business development objectives of the firm. The ideal candidate must have at minimum 3yrs of prior industry experience (insurance industry) along with an established network within the insurance industry. Ideal candidate maybe someone who is currently employed or has been in the Claims Industry, including but not limited to Investigative/Nurse Case Management/IME/DME sales area and looking for a change. Great opportunity with upward mobility. |
For more information contact us at employment@allianceinvestigative.com.
All inquiries kept confidential. (800) 579-2911 |
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Posted: 3/11/2010 |
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Senior Claims Examiner/Specialty Claims |
The New York Liquidation Bureau’s is looking for a Sr. Claims Examiner in its Estate Management Division. The New York Liquidation Bureau (“NYLB”) discharges the obligations of the New York State Superintendent of Insurance as the court-appointed statutory receiver of impaired or insolvent insurance companies. |
| The Senior Claims Examiner in the Specialty Claims Department is responsible for the adjudication of long tail complex Major Policyholder claims. The examiner may also handle other non SF covered claims in Liquidation & Rehabilitation including, but not limited to, D&O, HMO, Construction defects, Medical Malpractice & Labor Law. |
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Bachelor’s Degree |
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Minimum of 7 years experience handling multi-line claims or specialization. |
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Issue reservation of rights disclaimers. |
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Handle complex coverage issues, multistate venues. |
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Interfaces with TPA assigned to handle MPH claims covering Asbestos, Environmental & Products Liability. |
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Successful completion of professional training classes in particular area of expertise. |
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Experienced in claims handling, procedures, policy interpretation, liability evaluation, and settlement negotiation. |
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Computer competent, particularly in word & excel |
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| Extensive benefits and a salary commensurate with experience. Please email your resume to hr@nylb.org. |
| Equal Opportunity Employer M/F/D/V |
Lisa Ashton
Recruitment Coordinator
Human Resources Division
Telephone: 212/341-6887
Fax: 212/349-5810
email: lashton@nylb.org |
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New York Claim Association, Inc., 111 East 14th St, #180, New York, NY 10003 |
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