Senior Workers' Comp Claims Adjuster — Complex Claims Expert

PMA Companies; Roseville (CA); On-site; USD 80,000 - 105,000; Full time

Job summary

PMA Companies in Roseville, CA seeks an experienced Workers’ Compensation Claims Specialist to independently investigate, evaluate and resolve high‑complexity claims with minimal supervision. You will assess coverage, determine compensability, manage reserves and negotiate settlements in compliance with state statutes and company guidelines.

Key qualifications include a Bachelor's degree or 4+ years in insurance, 3–5 years in lost-time workers’ compensation, and active license or ability to

Qualifications

• Bachelor's degree or 4+ years of equivalent work experience in insurance required.
• 3–5 years' experience handling lost-time workers' compensation claims; California jurisdiction experience required.
• Active license required or ability to obtain license within 90 days in mandated states.
• Familiarity with medical terminology and/or Workers' Compensation.
• Strong organizational, independent-work capability with multitasking.

Responsibilities

• Investigate assigned claims with minimal supervision, including complex cases.
• Determine coverage, compensability, potential for subrogation, and second injury fund when applicable.
• Alert Supervisor and SIU to suspected claims.
• Ensure timely denial or payment of benefits per jurisdictional requirements.
• Establish and adjust reserves with rationale throughout the life of the claim.
• Negotiate settlements with client approval.
• Collaborate with PMA nurse professionals for return-to-work strategies.
• Manage service vendors to balance expenses and outcomes.
• Maintain knowledge of jurisdictional requirements and case law for states served.

Skills

Organizational skills

Verbal communication

Written communication

Customer service

Critical thinking

MS Office

Education

Bachelor's degree or 4+ years experience in insurance

Tools

Microsoft Office

Job description

PMA Companies in Roseville, CA seeks an experienced Workers’ Compensation Claims Specialist to independently investigate, evaluate and resolve high‑complexity claims with minimal supervision. You will assess coverage, determine compensability, manage reserves and negotiate settlements in compliance with state statutes and company guidelines.

Key qualifications include a Bachelor's degree or 4+ years in insurance, 3–5 years in lost-time workers’ compensation, and active license or ability to