Senior Workers' Comp Claims Expert

PMA Companies; Charlotte, Northern (NC, KY); Hybrid; USD 55,000 - 75,000; Full time

Job summary

PMA Companies, based in Charlotte, North Carolina, seeks a claims professional to independently investigate and resolve complex workers' compensation claims. You will determine coverage, reserves, and settlements while coordinating with PMA nurses on return‑to‑work plans.

3–5 years of experience in WC claims is preferred, with licensure within 90 days where required. Strong organization, communication, and MS Office skills are essential.

Qualifications

• Bachelor's degree or 4+ years of equivalent experience in insurance required
• Active license required or ability to obtain within 90 days in mandated states
• Familiarity with medical terminology and Workers' Compensation
• Strong organizational skills with ability to multitask independently
• Excellent analytical thinking with attention to detail
• Strong verbal and written communication skills
• Proficient with MS Office (Word, Excel, PowerPoint)

Responsibilities

• Investigate and resolve assigned workers' compensation claims, including complex cases, with minimal supervision
• Determine coverage and compensability, subrogation potential, and second injury fund applicability
• Notify Supervisor and SIU of potentially suspect claims
• Ensure timely denial or payment of benefits per jurisdictional requirements
• Establish and adjust reserves with documented rationale
• Negotiate settlements with client approval
• Develop action plans for case resolution including medical, disability, and litigation management
• Collaborate with PMA nurses to implement return‑to‑work strategies
• Select and manage service vendors balancing expense and loss outcomes
• Maintain knowledge of jurisdictional requirements and case law for each state served
• Communicate effectively with internal/external parties and provide high customer service

Job description

PMA Companies, based in Charlotte, North Carolina, seeks a claims professional to independently investigate and resolve complex workers' compensation claims. You will determine coverage, reserves, and settlements while coordinating with PMA nurses on return‑to‑work plans.

3–5 years of experience in WC claims is preferred, with licensure within 90 days where required. Strong organization, communication, and MS Office skills are essential.