Workers' Examiner

We are seeking an experienced Workers Comp Claims Specialist to manage a complex workers’ compensation desk with a strong emphasis on Pennsylvania lost-time and litigated claims
. This role handles primarily indemnity and complex files, with limited medical-only exposure, and requires collaboration with internal leadership and external stakeholders to ensure high‑quality, compliant claim outcomes. Manage a caseload of approximately 135 open indemnity and complex workers’ compensation claims
, including lost‑time files

• Handle a desk that is at least 50% litigated
  , working closely with defense attorneys
• Demonstrate strong working knowledge of Pennsylvania Workers’ Compensation regulations and practices
• Apply New Jersey and Delaware jurisdictional knowledge as required by assigned files
• Investigate claims, determine compensability, establish reserves, and manage ongoing exposure
• Coordinate medical care, wage loss benefits, and return-to-work efforts
• Communicate effectively with all stakeholders, including attorneys, injured workers, employers, carriers, and medical providers
• Utilize claims management systems to document activity, manage workflows, and meet service expectations
• Adhere to quality standards, production benchmarks, and client service level agreements (SLAs)
• Participate in internal reviews, audits, and performance evaluations
• Performance Measures Compliance with quality and accuracy standards
• Meeting production expectations for claim handling and resolution
• Adherence to client service level agreements (SLAs)
• Stakeholders External: Defense attorneys, injured workers, employers, clients, carriers, medical providers

• Experience & Knowledge 2–3 years of workers’ compensation claims experience
  , with a strong focus on indemnity and lost-time claims
• Extensive Pennsylvania workers’ compensation experience required
• Delaware experience preferred and may be eligible for additional consideration
• Prior experience handling litigated claims is required
• Licenses &
  
  Education:
  
  Adjuster's license in DE or a reciprocal state
• Assistance available to obtain license within 120 days
  , if not currently held
• Reciprocal licenses (Florida or Texas) accepted

Bachelor’s degree or equivalent relevant work experience

• Proficiency in Microsoft Office (Teams, Outlook/Email, Word)
• Experience using CareMC claims system preferred (not required)
• Strong documentation, organization, and time‑management skills