Senior Workers Compensation Claims Specialist
Listed on 2026-02-14
-
Insurance
Insurance Claims, Health Insurance, Insurance Analyst
Title
:
Senior Workers Compensation Claims Specialist
Location
:
Remote | candidates must reside in Western or Central PA with the ability to travel to Trenton, NJ for training
Job Type
:
Permanent/Direct-Hire
Compensation
: $79,000 - $90,000 per year
Our firm is partnering with a well-established regional property and casualty insurance organization to identify an experienced Senior Workers’ Compensation Claims Specialist
. This role supports policyholders and agents throughout Western and Central Pennsylvania, providing high-touch, advocacy-based claims service. While the position is fully remote, it includes regional travel and on-site engagement with policyholders, agents, and stakeholders. Initial training is conducted onsite at the client’s New Jersey office.
The Workers’ Compensation Claims team is service-driven and customer-focused, emphasizing transparency, empathy, and collaboration throughout the life of a claim. Claims professionals are supported by a dedicated call center and specialized internal units, allowing them to focus on strategic claim management, relationship-building, and optimal outcomes for injured workers and employers.
Job Description- Manage workers’ compensation claims in accordance with best practices, regulatory requirements, and internal guidelines, ensuring timely and accurate documentation
- Deliver high-quality customer service rooted in injured worker advocacy to improve outcomes for all parties
- Determine compensability and coverage by gathering and analyzing medical and factual evidence
- Administer timely, appropriate, and accurate benefit delivery
- Identify potential fraud indicators and escalate claims to Special Investigation Units as appropriate
- Recognize and investigate subrogation opportunities and coordinate referrals for third-party recovery
- Communicate proactively and professionally with injured workers, medical providers, attorneys, policyholders, and agents
- Apply critical thinking to evaluate exposures and develop proactive claim resolution strategies
- Assign claim petitions to legal counsel and work toward resolution within designated authority levels
- Build strong relationships with policyholders and agents, including conducting on-site investigations when needed
- Educate policyholders and agents on claims procedures, policies, and best practices
- Prepare for and participate in claim reviews at policyholder or agent locations in Western and/or Central Pennsylvania, or virtually as needed
- Serve as a liaison between policyholders, agents, and internal departments
- Represent workers’ compensation claims during onboarding and capability meetings for new policyholders
- Participate in ongoing training to remain current on regulatory, medical, and industry developments
- Recommend process improvements to enhance efficiency, service quality, and departmental performance
- Adhere to all compliance standards, ethical guidelines, and applicable laws related to claims handling
- 5+ years of experience as a Workers’ Compensation Claims Representative or equivalent experience handling complex WC claims
- Advanced knowledge of medical terminology and workers’ compensation regulations for Pennsylvania, Maryland, and/or Delaware
- Experience working with liens and Medicare Set-Asides to support full and final settlements
- Strong customer service orientation with excellent written and verbal communication skills
- Proven ability to work independently and collaboratively in a team environment
- Strong organizational, analytical, and decision-making skills
- Experience using automated claims processing systems and Microsoft Office tools (Word, Outlook)
- Active workers’ compensation adjuster license in Delaware and/or Connecticut, or ability to obtain required licenses within 90 days
- Ability to travel for business purposes approximately 2–3 days per week to meet with policyholders and agents
- Associate’s or bachelor’s degree
- Insurance designations such as AIC, CPCU, or similar
- Experience with Guidewire Claim Center, OnBase, and Microsoft Teams, Excel, and Power Point
- Experience handling other commercial lines claims across multiple states, including Pennsylvania, Maryland, and/or…
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