Reports directly to a member of the Risk Control Services Management team.  The Risk Control Representative within an internship (RCR-I), will be employed for 12 weeks (unless another time frame is negotiated) and complete a series of assignments related to client service with an emphasis on analysis of workers compensation risk characteristics and controls. The following are examples of work assignments during the internship: Complete client specific and industry analysis of loss trends and prepare exhibits for presentation Prepare client service reports and educational materials for distribution to mid-sized clients throughout the country Assist regional colleagues with client service projects as directed by your supervisor Work remote or in a PMA Companies office and have the opportunity during the internship to participate in field visits to clients with regional Risk Control team members Meet with various representatives of PMA to learn about the insurance industry...

As a key member of the Managed Care team, manage all relevant compliance activities and necessary staff to ensure appropriate execution of compliance initiatives, performance improvement across key categories, management of vendor/partner compliance activities, and consistent execution of best practices across functional areas. Responsibilities: Directs all Managed Care-related compliance activities, including but not limited to fee schedule updates, medical EDI transmissions, certified MCO applications/renewals, custom network (MPN, HCN) approvals, jurisdictional document compliance (EORs, UR letters, panel postings, etc.), bill reviewer and case manager certifications/licensure, PBM formulary compliance, and mandatory managed care state report filings. Plans staff responsibilities and directs activities, utilizing staff resources effectively to meet department goals in accordance with approved plans and budgets. Understands business objectives and utilizes that...

PMA Companies has a variety of positions available at our Customer Service Center (CSC). Our CSC is key to PMA's service proposition. It's comprised of professionals that provide support in the areas of medical bill handling, customer service, underwriting support, insurance processing and more. Our staff know firsthand PMA's systems and processes and focus on delivering superior customer service. Our culture is one of accountability, teamwork, and performance. Interested in joining our team? PMA is seeking candidates for the following positions: Customer Service Representative Loss Intake Representative Insurance Processor Medical Bill Reviewer Many of PMA's positions with the CSC allow for a remote, hybrid or in office work, depending on the role. Regardless of your work arrangement, you'll have the support you need from our leadership team and the opportunity to work with dedicated professionals who are committed to providing superior service to our clients....

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.   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...

The Licensing Coordinator is responsible for administering the adjuster licensing program. This role serves as the operational point of contact regarding all individual adjuster licensing matters and ensures compliance in accordance with the statutory regulations. Assist unlicensed employees with all aspects of adjuster licensing, including but not limited to, ordering study materials, providing guidance for preparation courses, and with scheduling examinations. Process license applications with the state agencies; facilitate bonding, background checks and fingerprinting as necessary, and expedite resolution of concerns throughout the process. Evaluate adjuster license expirations and renewal dates; communicate to the appropriate parties within the pre-designated timeframes to ensure a timely renewal process. Assign and release jurisdictional appointments with the company as required by the statute, as applicable. Organize Continuing Education Units (CEU) in partnership...

As a member of our underwriting support team you will provide a high level of support to the underwriting function. In this role you will assist in the preparation of new business quotes and policy issues as well as rating both new business and renew applications while maintaining accuracy and targeted due dates. Responsibilities: Correspond with various parties including rating bureaus clients and underwriting staff to support our underwriting efforts Ensures quality and timeliness of policies and correspondence and responds to customers inquiries Perform exposure comparisons and loss trending/developing review applications assure issuance of policies Quote/issue workers compensation line of coverage and process endorsements New business quote support tasks include classification of exposures completion of loss trend and analysis of large claim and prior audit information for renewal business requesting additional information as needed Review applications...

In this role, utilize your knowledge of commercial property, auto and liability claims to investigate, evaluate, reserve and resolve claims to achieve appropriate outcomes. Provide superior customer service to internal and external business partners. Administer and resolve assigned claims in a timely manner, in accordance to jurisdictional requirements, policy coverages and company guidelines.   Responsibilities: Promptly investigate all assigned claims for coverage, liability, damages, subrogation and contribution. Ensure timely disposition of all claims in accordance with regulatory and statutory requirements. Within granted authority, establish appropriate loss and expense reserves with documented rationale. Maintain and adjust reserves over the life of the claim to reflect changes in exposure. Notify appropriate claims management when exposure exceeds authority. Negotiate claims resolution within granted authority. Establish and execute appropriate action...

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, 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...

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, 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...

As a member of our Claims team, utilize your knowledge of Workers Compensation Claims 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 investigates all assigned claims with minimal supervision, including those of a more complex nature 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...

The Claims Apprentice Program is an exciting opportunity for recent college graduates interested in a career as a Claims Adjuster in the Property & Casualty insurance industry. As a Claims Apprentice, you will be trained by PMA's team of claims experts and leaders. Over the course of the nine-month program, you will develop your skills and knowledge in the area of workers' compensation and/or property and liability as well as assume a caseload of claims of increasing complexity. Job Responsibilities: Promptly investigate assigned claims. Determine coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable). Ensure timely denial or payment of benefits in accordance with jurisdictional requirements. Within granted authority, establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure. Negotiate claims settlements within granted authority....

This position will manage, evaluate and enhance the return-to-work process for absences related to personal and work-related illnesses for our client. The Workplace Accommodations Specialist will review job restrictions and accommodation requests as well as medical documentation in consideration for potential return-to-work opportunities. Responsibilities: Collaborates with client's Human Resources, Risk Management, and internal leadership teams to ensure compliance with ADA regulations. Evaluates job descriptions to maximize potential opportunities available to employees unable to return to their pre-disability positions. Monitors availability of work within temporary and permanent restrictions. Provides direction to all parties related to the area of expertise and acts as a subject matter expert on federal and state regulations and employer practices. Provides considerations of approval or denial of reasonable accommodations within the ADA requirements....

Reports directly to a member of the Risk Control Services Management team.  The Risk Control Representative within an internship (RCR-I), will be employed for 12 weeks (unless another time frame is negotiated) and complete a series of assignments related to client service with an emphasis on analysis of workers compensation risk characteristics and controls. The following are examples of work assignments during the internship: Complete client specific and industry analysis of loss trends and prepare exhibits for presentation Prepare client service reports and educational materials for distribution to mid-sized clients throughout the country Assist regional colleagues with client service projects as directed by your supervisor Work remote or in a PMA Companies office and have the opportunity during the internship to participate in field visits to clients with regional Risk Control team members Meet with various representatives of PMA to learn about the insurance industry...

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, 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...

PMA Companies has a variety of positions available at our Customer Service Center (CSC). Our CSC is key to PMA's service proposition. It's comprised of professionals that provide support in the areas of medical bill handling, customer service, underwriting support, insurance processing and more. Our staff know firsthand PMA's systems and processes and focus on delivering superior customer service. Our culture is one of accountability, teamwork, and performance. Interested in joining our team? PMA is seeking candidates for the following positions: Customer Service Representative Loss Intake Representative Insurance Processor Medical Bill Reviewer Many of PMA's positions with the CSC allow for a remote, hybrid or in office work, depending on the role. Regardless of your work arrangement, you'll have the support you need from our leadership team and the opportunity to work with dedicated professionals who are committed to providing superior service to our clients....

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.   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...

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. 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...

As a key member of the Managed Care team, manage all relevant compliance activities and necessary staff to ensure appropriate execution of compliance initiatives, performance improvement across key categories, management of vendor/partner compliance activities, and consistent execution of best practices across functional areas. Responsibilities: Directs all Managed Care-related compliance activities, including but not limited to fee schedule updates, medical EDI transmissions, certified MCO applications/renewals, custom network (MPN, HCN) approvals, jurisdictional document compliance (EORs, UR letters, panel postings, etc.), bill reviewer and case manager certifications/licensure, PBM formulary compliance, and mandatory managed care state report filings. Plans staff responsibilities and directs activities, utilizing staff resources effectively to meet department goals in accordance with approved plans and budgets. Understands business objectives and utilizes that...

Lead specific members of the Southwest Underwriting Service Team to include executing strategies consistent with corporate and regional business goals, guidelines, and programs within the Risk Management Services Department. Analyze, select and profitably price highly complex commercial risks and determine terms and conditions of coverage on new and renewal business. Apply and conform to underwriting rules and guidelines, rating manuals, insurance laws/ regulations. Utilize a consultative selling approach to generate new business consistent with underwriting strategy and in coordination with service team members to include accurately assessing the needs of the broker and the client and formulating solutions that effectively address those needs. Analyze underwriting & marketing activities and corresponding results; prepare reports to management. Mentor and provide technical training and guidance to direct reports. Determine, coordinate and direct account management...

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, 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...