Senior Workers' Compensation Claims Specialist | Remote

Our client is seeking an experienced Senior Workers' Compensation Claims Examiner to join their growing claims team. This individual will be responsible for managing a complex caseload of workers' compensation indemnity claims from inception through resolution while ensuring compliance with applicable state regulations, company guidelines, and industry best practices.

The ideal candidate will have strong technical workers' compensation claims expertise, excellent investigation and negotiation skills, and the ability to independently manage high-exposure, litigated claims in a fast-paced environment. Candidates must have prior experience handling Workers' Compensation claims in both Pennsylvania and New Jersey and possess a strong working knowledge of each state's statutes, regulations, and claims handling requirements. This is a remote opportunity.

Responsibilities

• Investigate new claims promptly and determine compensability in accordance with applicable state statutes and company guidelines.
• Administer workers' compensation benefits and oversee all aspects of claim handling from first notice through closure.
• Coordinate and manage medical treatment, authorize appropriate services, and review medical billing.
• Establish and maintain accurate claim reserves within assigned authority.
• Manage a caseload of approximately 100 - 110 workers' compensation indemnity claims, including highly complex files.
• Retain, direct, and collaborate with defense counsel on litigated claims.
• Communicate effectively with injured workers, employers, attorneys, medical providers, vendors, and internal stakeholders.
• Evaluate exposure, negotiate settlements, and obtain appropriate settlement authority when necessary.
• Maintain accurate claim documentation and diary management to ensure timely file activity.
• Identify injury trends and communicate relevant information to clients and internal partners.

Qualifications

• 3 - 7 years of Workers' Compensation claims handling experience with increasing responsibility.
• Must have experience handling Workers' Compensation claims in both Pennsylvania and New Jersey.
• Strong knowledge of Pennsylvania and New Jersey Workers' Compensation statutes, regulations, and claims handling requirements.
• Experience independently managing complex indemnity Workers' Compensation claims from inception through closure.
• Strong knowledge of medical terminology, claims investigations, reserve analysis, and settlement negotiations.
• Excellent analytical, organizational, negotiation, and decision-making skills.
• Strong written and verbal communication skills with the ability to effectively interact with injured workers, employers, attorneys, medical providers, and clients.
• Ability to manage multiple priorities while maintaining exceptional customer service.

Salary & Benefits

• $90,000 - $110,000 (Based on experience)
• PTO Days
• Comprehensive health, dental, vision, and life insurance options
• 401(k) plan with generous employer match