Job Description

Job Description

Job Description

Our client, an 'A' rated Insurance Carrier, is currently seeking an experienced Senior Workers' Compensation Claims Examiner with a proven track record in managing moderate to complex claims in Pennsylvania. This role requires a professional with experience in workers' compensation claims, who is adept at handling complex litigated and non-litigated Pennsylvania Lost Time with a focus on quality and efficiency. Our client is open to candidates working fully remote.

Key Responsibilities:

• Responsible for handling a caseload of 80 - 85 Lost Time Pennsylvania Workers' Compensation claims from inception to close.

• Negotiate settlements and authorize payments within delegated limits.

• Ensure compliance with all state regulatory requirements and internal policies.
• Communicate effectively with policyholders, medical professionals, employers, and legal counsel to gather information and resolve claims.
• Maintain accurate records and prepare reports for management regarding claim status and resolution.
• Attend hearings, mediations, and other legal proceedings as required.
• Provide guidance and training to junior claims staff and support their development.

Qualifications:

• 7+ years of experience as a Workers' Compensation Claims Examiner with a deep understanding of Pennsylvania Workers' Compensation Law

• Insurance Carrier experience is required

• Experience and strong knowledge in New Jersey Workers' Compensation Law is a plus

• Strong understanding of Pennsylvania EDI processes and transactions.

• Effective organizational skills and ability to work independently

• Bachelor’s degree in Business, Insurance, or a related field preferred.

Salary/Benefits:

• $95,000 to $110,000+ base salary plus Annual Bonus

• Employer matching 401(k) plan

• Extremely competitive Medical, Dental, Vision and Life plans

• Employer Contribution to HSA

• Generous PTO

• Flexible work schedule and ability to work from home

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