Senior Workers' Compensation Claims Adjuster

PMA Companies; Schaumburg (IL); On-site; USD 65,000 - 90,000; Full time

Job summary

PMA Companies is seeking an experienced Workers' Compensation Claims professional to independently investigate, evaluate, and resolve highly complex claims. You will administer and resolve high-risk claims in alignment with statutes, policy provisions, and company guidelines.

You will determine coverage, reserves, and potential subrogation while collaborating with nurses, attorneys, and vendors to drive timely, compliant outcomes.

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
• Ability to travel for business purposes, approximately less than 10%

Responsibilities

• Investigate assigned claims promptly with minimal supervision, including complex cases
• Determine coverage, compensability, subrogation potential, and second injury fund applicability
• Alert Supervisor and Special Investigations Unit to potentially suspect claims
• Ensure timely denial or payment of benefits per jurisdictional requirements
• Establish reserves with documented rationale and adjust over the life of the claim
• Negotiate settlements within granted authority
• Develop and implement action plans for case resolution (medical, disability, litigation)
• Coordinate with Lodestar nurse professionals on return-to-work strategies
• Select and manage service vendors to balance expenses and loss outcomes
• Maintain knowledge of jurisdictional requirements and applicable case law
• Communicate effectively with internal and external parties
• Provide high-level customer service during reviews and sessions
• Authorize treatment per Lodestar protocols
• Assist with panel provider information per state statutes
• Uphold Company Code of Conduct and Ethics

Skills

Organizational skills

Critical thinking

Verbal communication

Written communication

Customer service

Education

Bachelor's degree or equivalent

Tools

MS Office (Word, Excel, PowerPoint)

Job description

PMA Companies is seeking an experienced Workers' Compensation Claims professional to independently investigate, evaluate, and resolve highly complex claims. You will administer and resolve high-risk claims in alignment with statutes, policy provisions, and company guidelines.

You will determine coverage, reserves, and potential subrogation while collaborating with nurses, attorneys, and vendors to drive timely, compliant outcomes.