Senior Workers' Comp Claims Specialist (Remote)

PMA Companies; Northern (KY); Hybrid; USD 70,000 - 85,000; Full time

Job summary

PMA Companies is seeking a Claims Specialist - Workers Compensation to autonomously investigate, evaluate and resolve higher-risk workers' compensation claims. You will determine coverage and compensability, manage reserves, negotiate settlements, and coordinate with medical and vendor resources to optimize outcomes.

The role supports remote work with occasional travel and requires a Bachelor’s degree or 4+ years in insurance, plus licensing within 90 days where applicable.

Qualifications

• Bachelor's degree and/or four or more years of equivalent work experience required in an insurance related industry.
• License required or ability to obtain license within 90 days of employment in mandated states.
• Familiarity with medical terminology and/or Workers' Compensation.
• Working knowledge of Workers' Compensation regulations, preferably jurisdiction-specific.

Responsibilities

• Investigates assigned claims with minimal supervision, including complex cases.
• Determines coverage, compensability, potential for subrogation, and second injury fund considerations.
• Negotiates settlements within granted authority.
• Works with PMA nurse professionals to develop return-to-work strategies.
• Selects and manages service vendors to balance expenses and loss outcomes.

Skills

Investigative skills

Analytical skills

Verbal & written communication

Customer service

MS Office

Education

Bachelor's degree / 4+ years experience

Tools

MS Office

Job description

PMA Companies is seeking a Claims Specialist - Workers Compensation to autonomously investigate, evaluate and resolve higher-risk workers' compensation claims. You will determine coverage and compensability, manage reserves, negotiate settlements, and coordinate with medical and vendor resources to optimize outcomes.

The role supports remote work with occasional travel and requires a Bachelor’s degree or 4+ years in insurance, plus licensing within 90 days where applicable.