Claim Specialist I/II, Pennsylvania WC Claims

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Engages with insured individuals, injured workers, agents, brokers, witnesses, attorneys, loss prevention personnel, and underwriters to gather and communicate essential information for determining coverage, compensability, loss facts, and liability/exposure levels.

• Maintains ongoing communication throughout the duration of the claim file as necessary.

• Manages the timely, appropriate, and accurate delivery of indemnity and medical benefits.

• Assesses claim exposure, negotiates, and resolves claims effectively.

• Collaborates closely with defense attorneys on litigated cases and attends mediation, arbitration, and hearings as required.

• Formulates a litigation strategy with defense counsel and monitors adherence to this plan to control legal costs and ensure effective resolution.

• Works in partnership with insureds and employees, conducting visits and presentations as needed to enhance the claims handling process.

• Maintains high-quality claim files in compliance with best practices and company procedures.

• Implements Managed Care strategies, coordinates rehabilitation or medical management, processes bills, reviews all correspondence through Image Right, and tracks progress as appropriate.

• Engages with State and Federal Boards and Commissions, establishing and maintaining proper reserves as needed.

• Acts as a mentor and assists in training less experienced representatives in the Claims Department.

• Stays informed on State laws and Company procedures related to various claims; educates injured workers and/or insureds accordingly.

• Prepares and presents files for Agent/Broker Reviews and Insured File Reviews.

• Possesses an understanding of medical terminology and standard medical procedures relevant to worker’s compensation, U.S. Longshoreman’s, and Jones Act claims.

• Participates in both internal and external training programs to stay updated on pertinent issues and topics.

• Maintains a practical knowledge of all computer systems currently utilized.

• Travels across States as needed to manage assigned claims inventory.

• Pursues further education in claims through Associate in Claims or Claims Law (AEI) courses.

⛳️ Requirements

• Preferred one to two years of experience in handling lost time workers’ compensation claims.

• A Bachelor’s degree is preferred.

• Proficient in computer skills, including Word, Excel, and Image Right.

• A valid driver’s license is required.

• Strong attention to detail along with excellent verbal and written communication skills.

• Must be adaptable, flexible, and self-directed, with the ability to effectively manage time, multiple priorities, and resources.

• Ability to work collaboratively with other team members within the organization.

🏝️ Benefits

• Health Insurance options, Dental Insurance options, and Vision Insurance.

• Employee Life Insurance/AD&D and options for Dependent Life Insurance.

• Short-term and Long-term Disability coverage.

• Health Savings Account with potential employer matching contributions.

• Flexible Medical and Dependent Care Accounts.

• Accident Insurance coverage.

• Critical Illness Insurance options.

• Employee Assistance Program available.

• Legal and Identity Theft Insurance options.

• Long Term Care Insurance available.

• Pet Insurance options.

• 401(k) Retirement Plan with a match of up to 6%, plus an annual bonus based on individual and company performance.

• Five weeks of Paid Time Off (PTO).

• Eleven paid holidays.

• Flexible work schedules.

• Paid Parental Leave.

• Assistance with student loan paydown and refinancing.

• Educational support for job-related courses, seminars, certifications, or degrees.

• One paid day each year to volunteer for a non-profit of your choice.

• Sit-Stand desks and daily stretch breaks.