Assistant Claims Manager - Workers Compensation
PMA Companies

Provides strategic and technical claims leadership for TPA claims staff in collaboration with the Regional Claim Officer, to ensure appropriate claim outcomes through consistent execution of best claims practices. Directs staff in the achievement of business plan goals and compliance with legal statutes, policy provisions and company guidelines. Manages the execution of quality assurance programs.

Responsibilities:

• Develop, recommend and implements short and long term objectives consistent with company business goals, guidelines and program
• Provide client service management to select, high profile accounts. Manage the account management process and resolution of service issues to ensure superior customer service
• Effectively plan staff responsibilities and manage activities, utilizing staff resources to meet department goals in accordance with established business plans and budgets
• Monitor and analyze significant legal developments and legislative changes in service territories that may impact claim operations; communicates conclusions and recommendations to the appropriate parties
• Promote effective communication among and between work groups, and between management and employees. For PMAIC Unbundled accounts, collaborates with Corporate Specialists, Underwriting and Risk Control
• Provide strategic and technical claims leadership for assigned supervisors and staff in collaboration with the Regional Claim Officer and Quality Assurance staff
• Manage assigned supervisors and staff to ensure appropriate claim outcomes through consistent execution of best claims practices
• Direct assigned supervisors and staff in the achievement of business plan goals and compliance with legal statutes, policy provisions, special handling and company guidelines while fostering a culture of customer service excellence and professional accountability
• Ensure quality management of claims in accordance with best practices and company guidelines
• Provide coaching and training of assigned supervisors, as well as directly supervised staff, to develop technical proficiency, customer service excellence and leadership
• Ensure delivery of timely, high quality customer service from assigned supervisors as well as direct report staff
• Coordinate the effective delivery of managed care services within the branch ensuring consistent execution of managed care standards and guidelines
• Coordinate with the Regional Claim Officer the recruitment and hiring, performance management and resolution of employee relations issues within the branch; promoting effective communication among and between work groups within the branch
• Grant reserve and settlement authority on cases exceeding supervisor authority and ensure consistent execution of the CIR program for assigned supervisors
• 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.

• Bachelor's degree or equivalent experience.
• Typically 8 or more years of claims experience in positions of increasing responsibility.
• Prior leadership experience required.
• Extensive knowledge of claims regulations and applicable laws with specific knowledge of Workers' Compensation within servicing states, specifically NY, CT, MA, VT and RI.
• Extensive knowledge of insurance contracts, adjusting techniques and medical terminology.
• Remote opportunity may be considered for highly qualified candidates in the servicing area who are not local to a PMA office but willing to travel as needed.