Claims Apprentice - CA

Job Posted 11/16/2024
PMA Companies
Anaheim Hills, CA 92808
United States
Category
Job Description

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.
  • 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 to develop and execute return to work strategies.
  • Maintain a working knowledge of jurisdictional requirements and applicable case law for each state serviced.
  • Communicate effectively with internal and external parties on a wide variety of claims and account issues.
  • 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.
  • 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.
  • Minimum of an Associate's Degree but a Bachelor's Degree is preferred.
  • 1-3 years of work and/or volunteer experience in a service-oriented setting.
  • Leadership ability as demonstrated through participation in extra-curricular activities.
  • Strong organizational and multi-tasking skills.
  • Ability to work independently.
  • Strong critical thinking skills that demonstrate analysis, judgment and sound decision making.
  • Excellent verbal and written communication skills.
  • Excellent customer service skills.