Senior Workers' Comp Claims Specialist – Remote

PMA Companies; Cockeysville (MD); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Job summary

PMA Companies is seeking a Senior Claims Specialist - Workers Compensation to independently investigate, evaluate and resolve high complexity claims across jurisdictions. You will manage and resolve the most challenging cases in a timely manner in line with statutes, policy provisions and company guidelines.

Responsibilities include prompt investigation, determining coverage and compensability, establishing reserves, negotiating settlements, and coordinating with Lodestar nurses for

Qualifications

• 3–5 years' experience handling lost time workers' compensation claims.
• MD residency strongly preferred.
• Bachelor's degree or four+ years of equivalent work experience in insurance.
• Active license required or ability to obtain within 90 days in mandated states.

Responsibilities

• Promptly investigate all assigned claims with minimal supervision, including complex cases.
• Determine coverage, compensability, subrogation potential, and second injury fund when applicable.
• Alert Supervisor and SIU to 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 and implement action plans for case resolution including medical and disability management.
• Collaborate with Lodestar nurse professionals on return-to-work strategies.
• Select and manage vendors to balance expense and loss outcome.
• Maintain knowledge of state-specific requirements and case law.

Skills

WC Knowledge

Investigations

Communication skills

Analytical thinking

Negotiation

Education

Bachelor's degree or 4+ years of equivalent experience

Tools

MS Office

Job description

PMA Companies is seeking a Senior Claims Specialist - Workers Compensation to independently investigate, evaluate and resolve high complexity claims across jurisdictions. You will manage and resolve the most challenging cases in a timely manner in line with statutes, policy provisions and company guidelines.

Responsibilities include prompt investigation, determining coverage and compensability, establishing reserves, negotiating settlements, and coordinating with Lodestar nurses for