Remote Workers' Comp Claims Specialist

PMA Companies; Village of Bronxville (NY); À distance; USD 65 000 - 90 000; Plein temps

Résumé du poste

PMA Companies seeks a Back Claims Representative for Workers’ Compensation in NY. You will independently investigate, evaluate, and resolve complex claims, manage reserves, and coordinate with clinicians for return-to-work strategies. CA experience is valued and licensing within 90 days is required.

Responsibilities include negotiating settlements, ensuring compliance with state statutes, and interfacing with clients and vendors to optimize outcomes.

Qualifications

• Bachelor’s degree or 4+ years of relevant insurance experience
• CA experience is required; AZ experience is a plus
• AIC designation or similar professional designation desired
• License required or ability to obtain within 90 days in mandated states
• Familiarity with medical terminology and Workers' Compensation
• Knowledge of Workers' Compensation regulations, preferably jurisdiction-specific
• Strong organizational and multitasking skills
• Proven critical thinking and sound decision making with attention to detail
• Strong verbal and written communication and customer service skills
• MS Office proficiency (Word, Excel, PowerPoint)
• Ability to travel for business purposes, less than 10%

Responsabilités

• Investigates assigned claims with minimal supervision
• Determines coverage, compensability, subrogation potential, and second injury fund
• Alerts Supervisor and SIU to potentially suspect claims
• Ensures timely denial or payment of benefits per jurisdictional requirements
• Establishes and adjusts reserves with rationale and life-cycle updates
• Negotiates settlements within granted authority
• Develops action plans for case resolution including medical and disability management
• Collaborates with PMA nurse professionals on return-to-work strategies
• Selects and manages service vendors for balanced expense and outcomes
• Maintains knowledge of jurisdictional requirements and case law
• Communicates effectively with internal and external parties on claims issues
• Provides high-level customer service during reviews and stewardship meetings

Connaissances

Organizational skills

Critical thinking

Verbal communication

Written communication

Customer service

MS Office proficiency

Formation

Bachelor's degree

AIC designation

Outils

MS Office

Description du poste

PMA Companies seeks a Back Claims Representative for Workers’ Compensation in NY. You will independently investigate, evaluate, and resolve complex claims, manage reserves, and coordinate with clinicians for return-to-work strategies. CA experience is valued and licensing within 90 days is required.

Responsibilities include negotiating settlements, ensuring compliance with state statutes, and interfacing with clients and vendors to optimize outcomes.