Remote Workers' Comp Claims Specialist — Complex Claims

PMA Companies; Roseville (CA); Remote; USD 60,000 - 80,000; Full time

Job summary

PMA Companies in the United States is seeking a Claims Specialist for Workers' Compensation. This role focuses on independently investigating and resolving high-risk claims, while coordinating with nurses and vendors to manage outcomes.

Strong analytic and communication skills are essential to assess coverage, liability, and subrogation potential. Responsibilities include timely denial or payment of benefits, reserve management, and collaboration with internal teams to drive appropriate

Qualifications

• Degree or four+ years in an insurance-related role.
• Experience handling workers' compensation claims preferred.
• Competent in medical terminology and regulatory guidelines.

Responsibilities

• Investigates and resolves complex claims with minimal supervision.
• Assesses coverage, compensability, subrogation potential, and second injury fund relevance.
• Negotiates settlements within authority and manages reserves.
• Collaborates with PMA nurse teams on return-to-work strategies.
• Communicates with clients and vendors to support case outcomes.

Skills

Independent investigation

Analytical thinking

Communication skills

MS Office proficiency

Education

Bachelor's degree

Tools

MS Office

Job description

PMA Companies in the United States is seeking a Claims Specialist for Workers' Compensation. This role focuses on independently investigating and resolving high-risk claims, while coordinating with nurses and vendors to manage outcomes.

Strong analytic and communication skills are essential to assess coverage, liability, and subrogation potential. Responsibilities include timely denial or payment of benefits, reserve management, and collaboration with internal teams to drive appropriate