Senior Workers' Comp Claims Specialist (Remote)

PMA Companies; Camp Hill (Cumberland County); Remote; USD 70,000 - 95,000; Full time

Job summary

PMA Companies seeks a Sr. Claims Specialist to independently investigate and resolve high‑complexity workers’ compensation claims across multiple states. You will evaluate coverage, compensability, and subrogation while maintaining reserves and collaborating with PMA nurses on return‑to‑work strategies.

Independent work style with strong analytical and communication skills is essential, along with licensing readiness within 90 days for mandated states. Travel is minimal (<10%).

Qualifications

• Bachelor's degree, or four or more years of equivalent work experience required in an insurance related industry.
• At least 3-5 years' experience handling lost time workers' compensation claims; jurisdiction in MD, DC, WV and PA required.
• AIC designation or similar professional designation desired.
• Active license required or ability to obtain license within 90 days in mandated states.
• Familiarity with medical terminology and/or Workers' Compensation.
• Strong organizational skills and ability to work independently with multiple tasks.
• Proven critical thinking with attention to detail and sound judgment.
• Strong verbal and written communication and customer service skills.
• Proficient in MS Office suite.
• Travel approximately less than 10%.

Responsibilities

• Promptly investigate assigned claims with minimal supervision and for complex cases.
• Determine coverage, compensability, subrogation potential, and second injury fund where applicable.
• Alert Supervisor and Special Investigations Unit to potentially suspect claims.
• Ensure timely denial or payment of benefits per jurisdictional requirements.
• Establish and adjust reserves with documented rationale over the life of the claim.
• Negotiate settlements with client approval.
• Develop and implement action plans for case resolution including medical and disability management.
• Collaborate with PMA nurses to execute return-to-work strategies.
• Manage service vendors to balance expense and loss outcomes.
• Maintain knowledge of jurisdictional requirements and case law for states served.
• Demonstrate best claim practices and communicate with internal/external parties.
• Provide high level of customer service during reviews and stewardship meetings.

Skills

Organizational skills

Communication skills

Analytical thinking

Customer service

Education

Bachelor's degree or 4+ years experience

AIC designation desirable

Tools

MS Office

Job description

PMA Companies seeks a Sr. Claims Specialist to independently investigate and resolve high‑complexity workers’ compensation claims across multiple states. You will evaluate coverage, compensability, and subrogation while maintaining reserves and collaborating with PMA nurses on return‑to‑work strategies.

Independent work style with strong analytical and communication skills is essential, along with licensing readiness within 90 days for mandated states. Travel is minimal (<10%).