Senior Workers' Comp Claims Specialist – Remote

externalpmacompanies; City of Albany (NY); Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Remote work option

Job summary

externalpmacompanies is seeking a claims professional to independently investigate and resolve high‑complexity workers' compensation claims. You will determine coverage and damages, manage subrogation potential, and coordinate with SIU and medical teams.

The role emphasizes timely decisions, reserve management, and strong vendor collaboration. The candidate should have a Bachelor’s degree or 4+ years in insurance, CA experience, and an AIC or related designation is preferred.

Qualifications

• Bachelor's degree or 4+ years of equivalent insurance experience.
• CA experience required; AZ experience a plus.
• AIC designation or similar is desirable.
• License required or 90 days to obtain in mandated states.
• Knowledge of Workers' Compensation regulations and terminology.

Responsibilities

• Investigate complex claims with minimal supervision.
• Determine coverage, compensability and potential subrogation.
• Notify Supervisor or SIU of potentially suspect claims.
• Ensure timely denial or payment of benefits per jurisdiction rules.
• Establish and adjust reserves with documented rationale.
• Negotiate settlements within authority.
• Develop action plans for case resolution including medical and disability management.
• Collaborate with PMA nurses on return‑to‑work strategies.
• Select and manage vendors to balance expenses and outcomes.
• Maintain knowledge of jurisdictional requirements and case law.
• Communicate with internal and external parties about claims.

Skills

Claim investigations

Coverage determinations

Subrogation awareness

Negotiation

Communication skills

Return-to-work planning

Vendor management

Education

Bachelor's degree

AIC designation (desired)

Tools

MS Office

Job description

externalpmacompanies is seeking a claims professional to independently investigate and resolve high‑complexity workers' compensation claims. You will determine coverage and damages, manage subrogation potential, and coordinate with SIU and medical teams.

The role emphasizes timely decisions, reserve management, and strong vendor collaboration. The candidate should have a Bachelor’s degree or 4+ years in insurance, CA experience, and an AIC or related designation is preferred.