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Direct management of PMA's medical and vocational case management services; design and implement medical management and vocational rehabilitation services which align with and complement the organization's strategy, model and reputation. Responsible for operational leadership and direction of all aspects of the medical and vocational case management service solution, which supports and integrates
Posted Today
Completes projects that require data mining, analysis, and presentation. Use data reporting tools to develop reports and dashboards. (Hyperion, Qlik, MicroStrategy) Focuses on solutions, quickly identifies drivers in the data. Performs root cause analysis of issues. Identifies, analyzes and interprets trends or patterns in complex medical and pharmacy data sets. Acquires data from primary or secon
Posted 5 days ago
Provide accurate and timely resolution to claims customer service inquiries. Advise clients by telephone of status of claims inquiries. Handle escalated in bound calls to resolution. Coordinate client follow ups with appropriate claims adjusters. Provide technical and procedural guidance on all functions performed by the Call Center. Provide team member training as detailed on training schedules d
Posted 6 days ago
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
Posted 11 days ago
Provide accurate and timely resolution to claims customer service inquiries Advise Clients by telephone of status of claims inquiries Coordinate client follow ups with appropriate claims adjusters Provide support and back up assistance to other areas of CSC as needed Demonstrate commitment to Company's Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures,
Posted 12 days ago
Manage and monitor compliance processes (coordinate, assign, recommend corrective action, and perform secondary reviews/approval) and report findings to Senior Leadership. Coordinate compliance audits as needed and / or requested. Coordinate and provide training to ensure that all appropriate employees and management are knowledgeable of, and comply with, pertinent federal and state standards. Par
Posted 17 days ago
Plans the project Documents the scope and goals of the project in collaboration with business stakeholders and IS manager Demonstrates understanding of how the project aligns to corporate goals and objectives Determines the objectives and measures upon which the project will be evaluated at its completion Establishes alignment with internal audit department to provide appropriate project document
Posted 19 days ago
In this position, the Java developer will participate in the design, programming, testing, and implementation of applications. This requires programming requirements from verbal and written specifications received from other departments, in addition to participating in the support of new functionality subsequent to release. The developer will also take a leadership role to guide projects and mento
Posted 21 days ago
The Operations Business Analyst is responsible for support of our Underwriting Commercial Policy Decisions system which is utilized for commercial rating, quoting and issuance of policies. This position includes writing new requirements for our vendor when we add new programs, coverages and forms. Qualified candidates also will write test cases & execute them in our test environment to ensure the
Posted 1 month ago
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
Posted 1 month ago
The Information Systems Administrative Associate assists the management staff with financial and administrative functions. This includes invoicing, budgeting, contractor/employee onboarding and contract management. This position requires interaction with the Finance and Legal departments and well as external vendor partners. Processing of Information Services invoices using the corporate payables
Posted 1 month ago
Effectively identify, market and underwrite prospective accounts in targeted industries. Direct and monitor underwriting activities as required to produce positive profit and expense results within area of responsibility. Develop strong relationships with local Brokers/Agents and effectively articulate PMA's appetite. Solicit, review, and coordinate new business opportunities with agents and servi
Posted 1 month ago
Promptly investigates all assigned claims for coverage, liability assessment, damages evaluation and subrogation/contribution potential. Ensures timely disposition of all claims in accordance with regulatory and statutory requirements. Within granted authority, establishes appropriate loss and expense reserves with documented rationale. Maintains and adjusts reserves over the life of the claim to
Posted 1 month ago
Develops, recommends and implements short and long range objectives consistent with client's business goals, guidelines and programs. Evaluates program trends and provides recommendations and consultation to the customer to help improve outcomes. Delivers stewardships and assists customers with interpretation of data analytics specific to their program. Serves as a focal point of contact for the c
Posted 2 months ago
Support the pricing strategy of WC and PAL lines of business, including performing captive pricing analyses, providing pricing model support, researching industry trends, preparing collateral analyses and effectively communicating results to our business partners. Complete loss reserve analyses for various WC and PAL lines of coverage and effectively communicate assumptions, trends, selections and
Posted 2 months ago
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