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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 1 day ago
Gain the knowledge of applications systems through appropriate questioning approaches and effective use of provided documentation and mentorship. In conjunction with the appropriate Business units, assist with the project requirements gathering process, demonstrating the ability to facilitate discovery sessions, gain an understanding of the business process and translate them to system solutions.
Posted 3 days ago
Conduct investigation to determine a claim's subrogation potential and pursue appropriate recovery Identify, investigate and gather proper information in support of recovery opportunity in a timely and effective manner Prepare materials and documentation on unsettled claims to communicate to all relevant parties inclusive of; claims professionals, clients, attorneys, collection agencies and possib
Posted 7 days ago
Correspond with various parties including employers, injured workers and other parties within the claim process. Open, process and distribute incoming mail/packages to appropriate department and/or personnel. Perform various claims support functions including transactional functionality in Claim Center for administrative payments, recodes and database updates. Provide claim service delivery suppor
Posted 10 days ago
Design and implement a comprehensive audit program based on client specific requirements Educate claims staff on audit requirements and client expectations. Administer compliance, outcome, and client driven audits on a regular basis. Measure performance opportunities through use of calibration process, monthly, annual, and focus audits, and individual performance assessments. Develop and implement
Posted 11 days ago
Manage and complete multiple assignments on time and work under the close supervision of a Risk Control Manager Complete all required documentation for assignments Submit and review updated activity reports with your supervisor on a weekly basis Actively participate in conferences with PMA department representatives designed to heighten your awareness of the insurance industry and explore career o
Posted 13 days ago
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 18 days ago
The Corporate EDI Specialist is responsible for implementing techniques to reduce the financial impact and increase acceptance rate of state electronic reporting. This role provides high level EDI support to the local claim teams, focused on proactive claim management approaches to ensure compliance in accordance with the jurisdictional requirements. Review EDI Report daily to determine the reject
Posted 1 month 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 This shift as a Customer Service Representative is from 11 45 a.m. to 8 00 p.m. Demonstrate commitment to Company's Code of Business
Posted 1 month ago
At the direction of the Manager, Product Management and Development Accurate and timely preparation and filing of rates, rules, and forms Communicate loss costs, rules, and form changes to all applicable parties Coordinate answers to insurance department queries, and work closely with other state filings analysts to ensure consistency in answering questions Review and evaluate ISO/Bureau/NCCI circ
Posted 1 month ago
As a member of the Financial Department, you will be responsible for booking journal entries, performing monthly reconciliations, researching audit requests, and performing various other accounting and activity reconciliations. Essential Functions Prepare and settle monthly account statements on assigned captive reinsurance programs. Complete regular cash reconciliations of captive premium receipt
Posted 1 month ago
Promptly investigates all assigned claims for coverage, liability, damages, subrogation and contribution. Ensures timely disposition of all claims in accordance with client, 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 reflect changes in expo
Posted 1 month ago
Complete TPA renewal account pricing and assist with revenue management and reporting. Update and maintain data for financial forecasts, pricing, business planning, marketing and ad hoc reports. Under close supervision, review and approve retro adjustment calculations Communicate findings to supervisor in a logical, professional manner. Demonstrate commitment to Company's Code of Business Conduct
Posted 2 months ago
Provide technical support for application upgrades, enhancements, implementations, testing, issue resolution and other technical projects as assigned. Create, maintain, and support ad hoc reporting requests. Perform audit reports to analyze data to ensure accuracy and compliance of data among all applications in an effort to maintain data integrity. Assist in review, development and maintenance of
Posted 2 months ago
Analyze, select and profitably price coverage for large loss sensitive 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
Posted 3 months ago
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