Senior Workers' Compensation Claims Specialist (NJ/PA)

PMA Companies; Mount Laurel Township (NJ); Hybrid; USD 70,000 - 95,000; Full time

Job summary

PMA Companies is seeking a Sr Claims Specialist for Workers' Compensation in NJ/PA. The role focuses on independently investigating, evaluating and resolving high-complexity claims while aligning with statutes, policy provisions and company guidelines.

You will determine coverage, reserves, settlements, and coordinate with PMA nurses on return-to-work strategies, with limited supervision and travel as needed.

Qualifications

• Bachelor's degree or equivalent experience in an insurance-related field.
• 3-5 years' experience handling lost time workers' compensation claims; NJ/PA jurisdiction experience.
• Active license required or ability to obtain within 90 days in mandated states.
• Familiarity with medical terminology and workers' compensation.
• Strong organizational skills and ability to work independently with multiple tasks.
• Strong verbal and written communication and customer service skills.
• Computer literacy including MS Office (Word, Excel, PowerPoint).
• Ability to travel for business purposes (approximately <10%).

Responsibilities

• Investigate, evaluate and resolve assigned workers' compensation claims.
• Determine coverage, compensability, potential for subrogation, and second injury fund.
• Establish reserves with rationale and adjust over the life of the claim.
• Negotiate settlements with client approval.
• Develop and implement action plans for case resolution including medical and disability management.
• Collaborate with PMA nurses to execute return-to-work strategies.
• Manage service vendors to balance expenses and outcomes.
• Keep updated on jurisdictional requirements and case law.

Skills

Analytical thinking

Strong communication

Organizational skills

Customer service

Education

Bachelor's degree or 4+ years of equivalent experience

3-5 years' experience handling WC claims

Active license within 90 days

Tools

MS Office (Word, Excel, PowerPoint)

Job description

PMA Companies is seeking a Sr Claims Specialist for Workers' Compensation in NJ/PA. The role focuses on independently investigating, evaluating and resolving high-complexity claims while aligning with statutes, policy provisions and company guidelines.

You will determine coverage, reserves, settlements, and coordinate with PMA nurses on return-to-work strategies, with limited supervision and travel as needed.