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As a member of our Claims team, utilize your knowledge of Workers Compensation Claims 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.

Responsibilities:

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• Promptly investigates all assigned claims with minimal supervision, including those of a more complex nature
  
  
• Determines coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable)
  
  
• Alerts Supervisor and Special Investigations Unit to potentially suspect claims
  
  
• Ensures timely denial or payment of benefits in accordance with jurisdictional requirements
  
  
• Within granted authority, establishes appropriate reserves with documented rationale, maintains and adjusts reserves over the life of the claim to reflect changes in exposure
  
  
• Negotiates claims settlements within granted authority
  
  
• Establishes and implements appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition
  
  
• Works collaboratively with PMA nurse professionals to develop and execute return to work strategies
  
  
• Selects and manages service vendors to achieve appropriate balance between allocated expense and loss outcome
  
  
• Maintains a working knowledge of New York jurisdictional requirements and applicable case law for each state serviced
  
  
• Demonstrates technical proficiency through timely, consistent execution of best claim practices
  
  
• Communicates effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues
  
  
• Provides a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account-specific sessions
  
  
• Authorizes treatment based on the practiced protocols established by statute or the PMA Managed Care department
  
  
• Assists 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.
  
  

Target salary range - $62,000 - $88,000

#LI-Remote

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• Bachelor's degree and/or four or more years of equivalent work experience required in an insurance related industry required
  
  
• California jurisdiction experience required; AZ, ID, UT, NV and OR experience a plus
  
  
• Associate in Claims (AIC) Designation or similar professional designation desired
  
  
• License required or ability to obtain license within 90 days of employment in mandated states
  
  
• Familiarity with medical terminology and/or Workers' Compensation
  
  
• Working knowledge of Workers Compensation regulations, preferably jurisdiction-specific
  
  
• 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 gained through previous work experience
  
  
• Computer literacy, including working knowledge of MS Office Product Suite, i.e. Word, Excel, PowerPoint
  
  
• Ability to travel for business purposes, approximately less than 10%.
  
  

A MISSION WORTHY OF A CAREER!

If you’re looking for “just a job,” then stop reading right now. But, if you’re looking for a long-term federal law enforcement career, one that makes a difference every day to our country and its citizens, then the U.S. Border Patrol (USBP) would like you to take the first step to becoming an entry level Border Patrol Agent. 

USBP is hiring immediately to fill full-time,entry-level, career positions in federal law enforcement where your prior experience in public safety, security, military police or law enforcement may qualify. Train and work with an elite team of professionals whose camaraderie, pride, and sense of purpose are hallmarks of their daily mission of protecting America. 

Now is the time to make your move because, along with excellent base pay, exceptional benefits, and job stability, USBP is offering up to $60,000 in additional incentives (see details below).

Salary and Benefits

Annual base salary for newly appointed BPAs varies per grade, as follows: GL-5/GL-7 $51,632 - $92,219 per year. Border Patrol Agents are eligible to select from an array of federal employment benefits that include health, dental and other insurance plans, a generous annual and sick leave program, and participation in the Thrift Savings Plan, a retirement plan akin to a traditional ROTH 401(k) offering.

*Recruitment Incentive* Newly appointed Border Patrol Agents (as defined in 5 CFR 575.102) will be eligible for up to $20,000 in incentives. The first $10,000 will be paid upon successful completion of the Border Patrol Academy, with the remaining $10,000 awarded for accepting a prioritized location such as Sierra Blanca, Presidio, Sanderson, Comstock, Freer or Hebbronville, TX; Lordsburg, NM; or Ajo, AZ.

*Retention Incentive* Newly appointed Border Patrol Agents may also qualify for up to $40,000 in additional incentives distributed over their first four years.

Duty Locations

IMPORTANT NOTICE: Duty assignments available at the time of offer may include the Southwest Border, including prioritized locations.

U.S. Border Patrol determines duty assignments at the time of offer based on operational needs, which may or may not align with candidates’ first-choice preferences. RELOCATION MAY BE REQUIRED. 

Duty location impacts pay rates; locality pay for federal law enforcement is higher in some locations than others. A fully trained BPA may be eligible for up to an additional 25% of base pay per the BPA Pay Reform Act of 2014. This is a career ladder position with a grade level progression of GL-5, GL-7, GL-9, GS-11, and GS-12. You will be eligible for a promotion to the next higher grade level (without reapplying) once you successfully complete 52 weeks in each grade level. 

Duty Locations: You will be asked to select your preferred location for one of the following mission critical locations:

• Big Bend Sector Stations - *Presidio, Van Horn, *Sanderson, Alpine, *Sierra Blanca, Marfa

• Buffalo Sector Stations - Wellesley Island

• Del Rio Sector Stations - Del Rio, Brackettville, *Comstock, Eagle Pass North, Eagle Pass South, Carrizo Springs, Uvalde

• El Paso Sector Stations - Alamogordo, Clint, Deming, El Paso, Fort Hancock, Las Cruces, *Lordsburg, Santa Teresa, Ysleta

• El Centro Sector Stations - El Centro, Indio, Calexico

• Grand Forks Sector Stations - Pembina

• Havre Sector Stations - Havre, Malta, Plentywood, Scobey, Sweetgrass

• Houlton Sector Stations - Calais, Fort Fairfield, Jackman, Rangeley, Van Buren

• Laredo Sector Stations - Laredo South, Cotulla, *Hebbronville, Laredo West, *Freer, Laredo North, Zapata

• Rio Grande Valley Sector Stations - Rio Grande City, Fort Brown, McAllen, Brownsville, Falfurrias, Weslaco, Kingsville, Harlingen

• San Diego Sector Stations - Boulevard, Brownfield, Campo, Chula Vista, Imperial Beach, Murrieta, San Clemente

• Spokane Sector Stations - Colville, Curlew, Metaline Falls, Oroville

• Swanton Sector Stations - Beecher Falls, Burke, Champlain, Newport, Richford

• Tucson Sector Stations - *Ajo, Tucson, Nogales, Douglas, Brian A Terry, Sonoita, Casa Grande, Three Points Substation, Willcox

• Yuma Sector Stations - Blythe, Yuma, Wellton

Duties and Responsibilities

As a BPA, you will be part of our 60,000+ workforce that strives to protect the American people by safeguarding our borders, deterring illicit activity, and enhancing the nation’s economic prosperity. Being a BPA makes you a valuable member of the Federal Law Enforcement Officer (LEO) profession. 

Typical assignments include: 

• Detecting and questioning people suspected of violating immigration and custom laws and inspecting documents and possessions to determine citizenship or violations
• Preventing and apprehending undocumented noncitizens and smugglers of noncitizens at or near the borders by maintaining surveillance from covert positions to include using infrared scopes during night operations
• Interpreting and following tracks, marks, and other physical evidence of illegal entry of persons or contraband
• Performing farm checks, building checks, traffic checks, city patrols, and transportation checks
• Patrolling the international boundary and coastal waterways using a variety of government assets such as vehicles, horses, vessels, watercraft, off-road vehicles, ATVs, snowmobiles, and motorcycles for the accomplishment of the USBP Mission.

Qualifications

You qualify for the GL-5 grade level if you possess one of the following: 

Experience: One (1) year of general work experience that demonstrates the ability to take charge, make sound decisions, and maintain composure in stressful situations; to learn regulations, methods, and techniques through classroom training and/or on-the-job instruction; and the ability to gather concise information through questioning, observation, and examination of documents and records; OR 

Education Substitution: A bachelor's degree or successful completion of a full four-year course of study in any field leading to a bachelor's degree from an accredited college or university; OR 

Combination of Experience and Education: A combination of general work experience AND successfully completed college education. This will be calculated using your resume and official or unofficial transcripts submitted with your application. 

You qualify for the GL-7 grade level if you possess one of the following: 

Experience: One year of specialized work experience that shows you have the skills necessary to: 

• Make sound judgments and decisions in the use of firearms.
• Deal effectively with people in a courteous and tactful manner in connection with law enforcement matters.
• Analyze information rapidly and make prompt decisions where you will be expected to make arrests after the completion of required training and apply these skills in a law enforcement capacity such as criminal code enforcement, determining violations of laws, correctional or rehabilitation work involving criminal offenders, security, military, etc.

The above experience will be applied in connection with the following: Make arrests and exercise sound judgment in the use of firearms; deal effectively with people in a courteous manner in connection with law enforcement matters; analyze information rapidly and make prompt decisions; or develop and maintain contact with a network of informants.

Education Substitution for the GL-7 grade level: A bachelor's degree with superior academic achievement, which is based on (1) class standing, (2) grade-point average (i.e., GPA of 3.0 or higher out of a possible 4.0), or (3) honor society membership. Or will receive a bachelor's degree with Superior Academic Achievement. Or one full year of graduate-level education in a field of study related to law enforcement (e.g., criminal justice, homeland security, justice studies, law enforcement, courts and judicial systems, forensic technology, forensic psychology, or corrections and rehabilitation) from an accredited college or university; OR 

A Combination of Experience and Education: This will be calculated using your resume and official or unofficial transcripts submitted with your application. 

Note: If you have previous or current law enforcement or military law enforcement experience, you may qualify at the GL-9 and or GS-11 grade level. Please refer to the BPA GL-9 - 11 announcement.

Other Requirements

Citizenship: You must be a U.S. Citizen to apply for this position. 

Residency: You must have had primary U.S. residency (includes protectorates as declared under international law) for at least three of the last five years. 

Age Restriction: In accordance with Public Law 100-238, this position is covered under law enforcement retirement provisions. Candidates must be referred for selection to the Border Patrol Agent position before reaching their 40th birthday in accordance with Department of Homeland Security Directive 251-03. The age restriction may not apply if you are currently serving or have previously served in a federal civilian law enforcement (non-military)