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Senior Account Claims Adjuster - Commercial Auto - No Fault & Personal Injury Protection - Remote

Company: PMA Companies
Location: Mount Laurel
Posted on: March 20, 2023

Job Description:

Investigates, evaluates, and resolves Automobile Personal Injury Protection (PIP) and No Fault claims for self-insured and unbundled clients. Provides a superior level of customer service to internal and external business partners. Administers and resolves claims in a timely manner and in accordance with client, company, and regulatory guidelines. Responsibilities:

  • Promptly investigates all assigned claims for coverage, liability assessment, damages evaluation and subrogation/contribution. Ensures timely disposition of all claims in accordance with regulatory and statutory requirements.
  • Reviews claims to determine the nature of the loss and provides explanation of coverage benefits.
  • Research policy/contract and interpret policy/contract language to make coverage decisions based on 1 st party PIP and No Fault coverages/benefits.
  • Assess medical treatment, evaluate medical bills, records, wage loss documentation and address ongoing treatment and benefits.
  • 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 exposure. Notifies appropriate claim management when exposure exceeds authority. Negotiates claims resolution within granted authority.
  • Establishes and executes appropriate action plans for claim resolution including loss cost management.
  • Comply with Special Handling Guidelines of Client
  • Works collaboratively with internal and external business partners in investigating and reaching appropriate disposition of all claims.
  • Selects and manages service vendors in accordance with company and client special handling guidelines.
  • Refer claims to other company units and client when necessary (Recovery Unit, Special Investigation Unit, etc.)
  • Maintains a strong working knowledge of Personal Injury Protection/No Fault laws, regulations and jurisdictional requirements.
  • Demonstrates technical proficiency through timely, consistent execution of best claim practices and established claims handling guidelines.
  • Communicates effectively with internal and external customers on claims and account issues.
  • Maintain and manage a diary system and claim pending to resolve all claims efficiently and effectively.
  • Effectively manage the arbitration and litigation process. Manage counsel to ensured timely, equitable, and cost-effective outcomes.
  • Prepares and submits claim status and excess reports to client and their excess carrier(s)
  • Demonstrate commitment to Company's Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards, and laws applicable to job responsibilities in the performance of work.

Keywords: PMA Companies, Philadelphia , Senior Account Claims Adjuster - Commercial Auto - No Fault & Personal Injury Protection - Remote, Other , Mount Laurel, Pennsylvania

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