Workers' Compensation Claims Adjuster

This is a fully remote position, open to applicants in New Jersey, +2 more states.

📋 Description

• Investigate, assess, and adjust Pennsylvania Workers’ Compensation claims from initial assignment to final closure.

• Establish reserves or provide reserve recommendations within defined authority limits.

• Review, approve, or supervise medical, legal, damage estimate, and various invoices.

• Negotiate disputed bills and invoices.

• Authorize and execute claim payments in accordance with procedures, industry standards, and payment authority.

• Negotiate settlements based on corporate standards, client directives, and state regulations.

• Select, refer, and oversee external vendors such as legal, surveillance, and case management service providers.

• Assess and monitor subrogation claims.

• Review and maintain claim diaries within the claims management system.

• Prepare reports outlining claim status, payments made, and reserves.

• Calculate disability rates in compliance with state regulations.

• Coordinate timely communications with clients, claimants, and other stakeholders.

• Prepare newsletter articles as needed.

• Provide qualifying claim notifications to excess/reinsurance carriers.

• Manage complex claims with minimal supervision.

• Conduct claim reviews and training sessions for designated clients.

• Attend and engage in hearings, mediations, and informal legal conferences.

• Adhere to corporate claim-handling standards and specific client instructions.

• Support clients' risk management objectives through tailored claim solutions and technology.

⛳️ Requirements

• Over 5 years of experience in handling Pennsylvania Workers' Compensation claims.

• Proven experience managing claims from investigation to closure.

• Extensive knowledge of Pennsylvania Workers' Compensation laws and claims handling practices.

• Experience with indemnity claims.

• Proficient in establishing reserves and evaluating claim exposure.

• Ability to independently manage a full caseload.

• Excellent written and verbal communication skills.

• Strong negotiation and problem-solving capabilities.

• Exceptional organizational, diary management, and time-management skills.

• Ability to work autonomously in a remote setting.

• Proficient in Microsoft Office applications, including Outlook, Word, and Excel.

• Reliable attendance during designated business hours.

• Experience with carrier claims is preferred.

• Preferred experience in litigation management.

• Experience with Black Lung claims is preferred.

• Preferred experience supporting dedicated claim programs.

• Prior experience with Third-Party Administrators (TPA) is preferred.

• Professional designations such as AIC, CPCU, ARM, or WCP are preferred.

• Visa sponsorship is not available.

🏝️ Benefits

• 4 weeks of paid time off.

• 10 paid holidays in your first year.

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Life insurance.

• Disability insurance.

• 401(k) plan.

• Employee Stock Ownership Plan (ESOP).

• Opportunities for internal training and career advancement.

• Supportive, team-oriented work environment.

• Potential bonuses or additional forms of compensation may be available.