Senior Remote Workers' Comp Claims Specialist

externalpmacompanies; Fresno (CA); Remote; USD 60,000 - 80,000; Full time

Job summary

PMA Companies is seeking an experienced claims professional to independently investigate and resolve complex workers’ compensation claims. You will determine coverage, reserves, and settlements, while coordinating with medical and return-to-work teams to manage high-risk cases.

The role requires CA workers’ compensation experience, a relevant degree or 4+ years in insurance, and the ability to obtain licensure within 90 days. Travel is minimal as needed.

Qualifications

• Bachelor's degree or 4+ years in insurance required.
• CA experience required in Workers' Compensation.
• License required or ability to obtain license within 90 days.
• Familiarity with medical terminology and WC regulations.
• Strong organizational skills and attention to detail.

Responsibilities

• Investigate complex workers' compensation claims with minimal supervision.
• Determine coverage, compensability, and subrogation potential.
• Communicate findings and resolutions with clients and internal teams.
• Negotiate settlements within authority and manage case reserves.
• Support return-to-work strategies with PMA nurse professionals.

Skills

CA experience

Strong communication

MS Office

Independent worker

Education

Bachelor's degree or equivalent

AIC designation

Tools

MS Office Suite

Job description

PMA Companies is seeking an experienced claims professional to independently investigate and resolve complex workers’ compensation claims. You will determine coverage, reserves, and settlements, while coordinating with medical and return-to-work teams to manage high-risk cases.

The role requires CA workers’ compensation experience, a relevant degree or 4+ years in insurance, and the ability to obtain licensure within 90 days. Travel is minimal as needed.