Senior Workers' Compensation Claims Specialist

PMA Companies; Camp Hill (Cumberland County); On-site; USD 60,000 - 90,000; Full time

Job summary

PMA Companies in Camp Hill, PA seeks a claims professional to independently investigate, evaluate, and resolve highly complex workers' compensation claims. This role handles highest risk management expectations to ensure timely outcomes in line with statutes and company guidelines.

Responsibilities include reserving, settlement negotiations, and coordinating with PMA nurse professionals on return-to-work plans.

Qualifications

• Bachelor's degree or 4+ years equivalent work experience in insurance required.
• 3-5 years' experience handling lost time workers' compensation claims; MD, DC, WV and PA jurisdiction experience preferred.
• Active license required or ability to obtain license within 90 days in mandated states.
• Knowledge of medical terminology and Workers' Compensation.

Responsibilities

• Investigate assigned claims with minimal supervision, including complex cases.
• Determine coverage, compensability, subrogation potential, and second injury fund applicability.
• Alert Supervisor and SIU 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 with client approval.
• Develop action plans for case resolution including medical, disability, litigation management and disposition.
• Collaborate with PMA nurse professionals on return-to-work strategies.
• Select and manage vendors to balance expenses and loss outcomes.
• Maintain knowledge of state requirements and applicable case law.

Skills

Analytical thinking

Strong organizational skills

Critical thinking

Verbal and written communication

Customer service

Education

Bachelor's degree or 4+ years equivalent experience

Tools

MS Office (Word, Excel, PowerPoint)

Job description

PMA Companies in Camp Hill, PA seeks a claims professional to independently investigate, evaluate, and resolve highly complex workers' compensation claims. This role handles highest risk management expectations to ensure timely outcomes in line with statutes and company guidelines.

Responsibilities include reserving, settlement negotiations, and coordinating with PMA nurse professionals on return-to-work plans.