Remote Claims Specialist – Medical & Workers' Comp

PMA Companies; Roseville (CA); Remote; USD 58,000 - 73,000; Full time

Job summary

PMA Companies seeks an Associate Claims Specialist to join the Roseville, CA team. You will manage medical only and limited lost time claims, ensuring timely setup, processing payments, and coordinating with network physicians.

The role requires 1+ year of workers' compensation claims handling, a high school diploma or equivalent, and the ability to obtain state licenses within 90 days. Strong communication and organizational skills are essential for success.

Qualifications

• High school diploma or equivalent.
• One or more years of Workers' Compensation claims handling experience.
• License required or ability to obtain license within 90 days in mandated states.
• Familiarity with medical terminology.
• Ability to work independently and manage multiple tasks.
• Strong organizational skills.
• Excellent verbal and written communication skills.
• Proficiency MS Excel and MS Word.

Responsibilities

• Contact accounts on First Notices of Loss to obtain missing information for file setup.
• Process payments, answer calls, and authorize treatment for Medical Only claims.
• Complete contacts within 24 hours of assignment and maintain follow-up diaries.
• Determine whether treatment is appropriate and causally related to the injury.
• Redirect treatment to network physicians as appropriate.
• Refer subrogation or permanency claims to Supervisor.
• Ensure compliance with jurisdictional requirements on Medical Only claims and filing.

Skills

Workers' Compensation claims handling

MS Excel

MS Word

Education

High school diploma or equivalent

Tools

MS Excel

MS Word

Job description

PMA Companies seeks an Associate Claims Specialist to join the Roseville, CA team. You will manage medical only and limited lost time claims, ensuring timely setup, processing payments, and coordinating with network physicians.

The role requires 1+ year of workers' compensation claims handling, a high school diploma or equivalent, and the ability to obtain state licenses within 90 days. Strong communication and organizational skills are essential for success.