Remote Senior Workers' Comp Claims Specialist

PMA Companies; Tampa (FL); Remote; USD 70,000 - 100,000; Full time

Job summary

PMA Companies in Tampa, FL is seeking a Senior Claims Specialist in Workers' Compensation to independently investigate, evaluate, and resolve high-complexity claims. You will determine coverage, reserves, and subrogation opportunities while coordinating with care and vendor partners to manage outcomes.

Ideal candidates bring 3–5 years of workers’ compensation experience, active FL license, and strong analytical and communication skills to support timely decisions and exceptional client service.

Qualifications

• Bachelor's degree or four or more years of equivalent work experience in an insurance related industry.
• 3–5 years' experience handling lost time workers' compensation claims.
• Active license required or ability to obtain license within 90 days of employment.
• Familiarity with medical terminology and workers' compensation.
• Strong organizational and independent work skills.
• Proven verbal and written communication and customer service abilities.
• Ability to travel for business purposes, approximately less than 10%.

Responsibilities

• Promptly investigate all assigned claims with minimal supervision, including complex cases.
• Determine coverage, compensability, and subrogation potential.
• Alert Supervisor and Special Investigations Unit to suspicious claims.
• Ensure timely denial or payment of benefits per jurisdictional requirements.
• Establish reserves with rationale and adjust over the life of the claim.
• Negotiate settlements with client approval.
• Develop action plans for case resolution including medical and disability management.
• Collaborate with Lodestar nurse professionals on return-to-work strategies.
• Select and manage service vendors to balance expenses and loss outcomes.
• Maintain knowledge of jurisdictional requirements and case law for states served.
• Communicate effectively with internal and external parties on claims issues.
• Provide high level customer service during reviews and sessions.

Skills

Strong organizational skills

Critical thinking

Verbal and written communication

Customer service skills

Education

Bachelor's degree or equivalent

Tools

MS Office

Job description

PMA Companies in Tampa, FL is seeking a Senior Claims Specialist in Workers' Compensation to independently investigate, evaluate, and resolve high-complexity claims. You will determine coverage, reserves, and subrogation opportunities while coordinating with care and vendor partners to manage outcomes.

Ideal candidates bring 3–5 years of workers’ compensation experience, active FL license, and strong analytical and communication skills to support timely decisions and exceptional client service.