Workers' Compensation Claims Adjuster

Worker Compensation Claims Adjuster 

Job Summary: 

We are looking for a motivated entry-level Claims Adjuster to join our team handling workers’ compensation claims in Pennsylvania. This role focuses on investigating, managing, and resolving medical-only and minor lost-time claims under close supervision while learning Pennsylvania workers’ compensation laws and best practices.

Responsibilities:

●      Receive and Review New Claims: Gather initial reports from employers, employees, and witnesses about work-related injuries or illnesses.

●      Investigate Claims: Contact claimants, employers, and medical providers; review medical records, accident reports, and other documents to verify if the injury is work-related and covered.

●      Determine Compensability: Decide whether to accept or deny the claim based on Pennsylvania workers’ comp laws (e.g., was it in the course of employment?). Entry-level roles often handle straightforward cases with limited authority.

●      Manage Benefits: For approved claims, process medical bills, approve treatments, coordinate care, and calculate/ issue wage-loss payments.

●      Set Reserves: Estimate and set aside money for the expected cost of the claim.

●      Proper Claim File Documentation: Maintain detailed claim files, notes, and status reports in compliance with state rules and company policies.

●      Identify Issues: Spot potential fraud, subrogation (recovering costs from third parties), or complex matters and escalate them to a supervisor.

●      Close Files: Finalize and close simple claims when the worker recovers and returns to 

Required Skills & Qualifications: 

●      High school diploma. (College/University diploma preferred).

●      Strong communication (oral and written), organization, and analytical skills.

●      Basic computer proficiency (Microsoft Office, claims software).

●      Ability to interpret medical info and apply laws/regulations (will be trained in how to do so).

Preferred Qualifications: 

●      Prior experience handling Pennsylvania workers’ compensation claims preferred. 

●      Familiarity with claims systems or regulatory reporting tools (EDI (WCAIS), CMS, PCRB)

●      Licensure (as a producer, or any claims’ designation) Not Required