Senior Claims Adjuster - Ohio Workers Compensation - Remote at PMA Companies

Posted in Other 16 days ago.

Location: Lexington, Kentucky

Job Description:

As a member of our claims team, utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position you will administer and resolve highest risk management expectations claims in a timely manner in accordance with legal statues, policy provisions, and company guidelines.


  • 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 appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure.

  • Negotiate claims settlements with client approval.

  • 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.

  • Select and manage service vendors to achieve appropriate balance between allocated expense and loss outcome.

  • Maintain a working knowledge of jurisdictional requirements and applicable case law for each state serviced.

  • Demonstrate technical proficiency through timely, consistent execution of best claim practices.

  • Communicate effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues.

  • Provide a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account-specific sessions.

  • 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.


  • Bachelor's degree or four or more years of equivalent work experience.

  • At least 3-5 years' experience handling lost time Workers Compensation claims in OH.

  • OH jurisdictional experience required, KY experience a plus.

  • Associate in Claims (AIC) Designation or similar professional designation desired.

  • Familiarity with medical terminology.

  • Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously.

  • Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details.

  • Strong verbal, written communication skills and customer service skills.

  • Computer literacy, including working knowledge of MS Office Product Suite, i.e. Word, Excel, PowerPoint.

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