Pennsylvania Workers' Claims Adjuster; Remote

Workers' Compensation Claim Consultant - Pennsylvania

The Workers' Compensation Claim Consultant is responsible for the investigation, evaluation, administration, and resolution of Pennsylvania Workers' Compensation claims from assignment through final closure. This role supports a dedicated carrier program and offers the opportunity to develop deep expertise within a single jurisdiction while building strong client and stakeholder relationships.

The successful candidate will manage a caseload of claims ranging from moderate complexity to more complex exposures depending on experience and skill level. Claims may include litigated matters, ongoing medical management, indemnity benefits, return-to-work coordination, and settlement opportunities.

This role is designed for experienced Pennsylvania Workers' Compensation adjusters who can independently manage a full inventory, exercise sound judgment, communicate effectively with all parties, and consistently deliver high-quality claim outcomes.

When we hire Workers' Compensation Adjusters at CCMSI, we look for detail-driven problem-solvers who balance empathy with sound judgment, navigate complex regulations with confidence, and deliver fair, timely outcomes that support injured workers and strengthen client trust.

• Investigate, evaluate and adjust claims in accordance with established claim handling standards and laws.
• Establish reserves and/or provide reserve recommendations within established reserve authority levels.
• Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated claims. Negotiate any disputed bills or invoices for resolution.
• Authorize and make payments of claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.
• Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate.
• Assist in the selection, referral and supervision of designated claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.)
• Assess and monitor subrogation claims for resolution.
• Review and maintain personal diary on claim system.
• Client satisfaction.
• Prepare reports detailing claim status, payments and reserves, as requested.
• Compute disability rates in accordance with state laws.
• Effective and timely coordination of communication with clients, claimants and appropriate parties throughout the claim adjustment process.
• Prepare newsletter articles, as requested.
• Provide notices of qualifying claims to excess/reinsurance carriers.
• Handle more complex and involved claims than lower level claim positions with minimum supervision.
• Conduct claim reviews and/or training sessions for designated clients, as requested.
• Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.
• Compliance with Corporate Claim Handling Standards and special client handling instructions as established.

• 5+ years of Pennsylvania Workers' Compensation claims handling experience
• Experience managing claims from investigation through closure
• Strong knowledge of Pennsylvania Workers' Compensation laws and claim handling practices
• Experience handling indemnity claims
• Experience establishing reserves and evaluating claim exposure
• Ability to independently manage a full caseload
• Strong written and verbal communication skills
• Effective negotiation and problem-solving abilities
• Strong organizational, diary management, and time-management skills
• Ability to work independently in a remote environment
• Proficiency with Microsoft Office applications, including Outlook, Word, and Excel
• Reliable attendance during established business hours

• Carrier claims experience
• Litigation management experience
• Black Lung claims experience
• Experience supporting dedicated claim programs
• Prior TPA experience
• Professional designations such as:
  • AIC
  • CPCU
  • ARM
  • WCP

• 4 weeks (Paid time off that accrues throughout the year in accordance with…