|
Tampa,
FL
(Click company name to view employer profile and all available
positions.) |
|
|
|
|
|
Career Field |
Claims, Workers' Compensation
|
| Insurance
Discipline |
Property & Casualty
|
| Relocation
Assistance |
Not Available
|
| Job
Duration |
Full Time |
| Salary
Offered |
Open |
|
|
|
|
As a member of our TPA claims team, utilize your knowledge of Workers Compensation claims to independently investigate, evaluate and resolve assigned claims of a complex nature for self insured clients. 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.
Essential Functions:
• 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, maintains and adjusts reserves over the life of the claim to reflect changes in exposure
• Negotiate claim settlements within granted authority
• 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 on return to work strategies
• Select and manage service vendors to balance allocated expense and loss outcome
• Maintain knowledge of applicable jurisdictional requirements and case law
• Demonstrate technical proficiency through timely, consistent execution of best claim practices
• Communicate effectively, verbally and in writing with internal/ external parties
• Provide a high degree of customer service to clients, including face to face interactions during claims reviews and stewardship meetings
• 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
Qualifications:
• Bachelor's degree and/or four+ years of workers compensation claims handling experience.
• Associate in Claims (AIC) Designation or similar professional designation desired
• Knowledge of Florida jurisdiction Workers Compensation and medical terminology
• Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously
• 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 %
|
|
|
|
|
|
|
 |
|
|
| Quick Links |
|
|
Copyright © 2001-2007 Great Insurance Jobs, Inc. All Rights Reserved.
Insure Your Future™ is a registered trademark of Great Insurance
Jobs, Inc.
|
