Sr. Claims Specialist - Camp Hill, PA

PMA Companies; Camp Hill (Cumberland County); Remote; USD 70.000 - 95.000; Vollzeit

Zusammenfassung

PMA Companies seeks a Sr. Claims Specialist to independently investigate and resolve high‑complexity workers’ compensation claims across multiple states. You will evaluate coverage, compensability, and subrogation while maintaining reserves and collaborating with PMA nurses on return‑to‑work strategies.

Independent work style with strong analytical and communication skills is essential, along with licensing readiness within 90 days for mandated states. Travel is minimal (<10%).

Qualifikationen

• Bachelor's degree, or four or more years of equivalent work experience required in an insurance related industry.
• At least 3-5 years' experience handling lost time workers' compensation claims; jurisdiction in MD, DC, WV and PA required.
• AIC designation or similar professional designation desired.
• Active license required or ability to obtain license within 90 days in mandated states.
• Familiarity with medical terminology and/or Workers' Compensation.
• Strong organizational skills and ability to work independently with multiple tasks.
• Proven critical thinking with attention to detail and sound judgment.
• Strong verbal and written communication and customer service skills.
• Proficient in MS Office suite.
• Travel approximately less than 10%.

Aufgaben

• Promptly investigate assigned claims with minimal supervision and for complex cases.
• Determine coverage, compensability, subrogation potential, and second injury fund where applicable.
• Alert Supervisor and Special Investigations Unit to potentially suspect claims.
• Ensure timely denial or payment of benefits per jurisdictional requirements.
• Establish and adjust reserves with documented rationale 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 expense and loss outcomes.
• Maintain knowledge of jurisdictional requirements and case law for states served.
• Demonstrate best claim practices and communicate with internal/external parties.
• Provide high level of customer service during reviews and stewardship meetings.

Kenntnisse

Organizational skills

Communication skills

Analytical thinking

Customer service

Ausbildung

Bachelor's degree or 4+ years experience

AIC designation desirable

Tools

MS Office

Jobbeschreibung

Sr. Claims Specialist

#4928

Multiple Locations

Job Description

As a member of our claims team, utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position you will administer and resolve highest risk management expectations claims in a timely manner in accordance with legal statues, policy provisions, and company guidelines.

#LI-Remote

Responsibilities

• Promptly investigate all assigned claims with minimal supervision, including those of a more complex nature
• Determine coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable)
• Alert Supervisor and Special Investigations Unit to potentially suspect claims
• Ensure timely denial or payment of benefits in accordance with jurisdictional requirements
• Establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure
• Negotiate claims settlements with client approval
• Establish and implement appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition
• Work collaboratively with PMA nurse professionals to develop and execute return to work strategies
• Select and manage service vendors to achieve appropriate balance between allocated expense and loss outcome
• Maintain a working knowledge of jurisdictional requirements and applicable case law for each state serviced
• Demonstrate technical proficiency through timely, consistent execution of best claim practices
• Communicate effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues
• Provide a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account-specific sessions
• Authorize treatment based on the practiced protocols established by statute or the PMA Managed Care department
• Assist PMA clients by suggesting panel provider information in accordance with applicable state statutes.
• Demonstrate commitment to Company's Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.

Requirements

• Bachelor's degree, or four or more years of equivalent work experience required in an insurance related industry required
• At least 3-5 years' experience handling lost time workers compensation claims required; past experience with MD, DC, WV and PA jurisdiction is required
• Associate in Claims (AIC) Designation or similar professional designation desired.
• Active license required or ability to obtain license within 90 days of employment in mandated states.
• Familiarity with medical terminology and/or Workers' Compensation
• Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously
• Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details
• Strong verbal, written communication skills and customer service skills
• Computer literacy, including working knowledge of MS Office Product Suite, i.e. Word, Excel, PowerPoint.
• Ability to travel for business purposes, approximately less than 10%.

Alternate Location(s)

• Hunt Valley, Maryland, United States
• Camp Hill, Pennsylvania, United States
• Charleston, West Virginia, United States