Workers' Compensation Claims Adjuster

🔥 0 minutes ago

🏖️ New Jersey, Ohio, +1 more states – Remote

🏖️ New Jersey – Remote 🏈 Ohio – Remote 🔔 Pennsylvania – Remote

💵 $65k - $85k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 Ghost score 0%

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CCMSI

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1978

🏗️ Construction

🏥 Healthcare

📦 Logistics

Construction • Healthcare • Logistics

CCMSI is a company that provides comprehensive risk management services, focusing on claims management and consulting solutions. They offer services to help organizations mitigate risks, reduce costs, and improve operational efficiency through their expertise in claims handling and risk assessment.

📋 Description

• Investigate, evaluate, and adjust Pennsylvania Workers’ Compensation claims from assignment through final closure • Establish reserves or provide reserve recommendations within established authority levels • Review, approve, or oversee medical, legal, damage estimate, and miscellaneous invoices • Negotiate disputed bills and invoices • Authorize and make claim payments according to procedures, industry standards, and payment authority • Negotiate settlements according to corporate standards, client instructions, and state laws • Select, refer, and supervise outside vendors such as legal, surveillance, and case management providers • Assess and monitor subrogation claims • Review and maintain claim diaries in the claim system • Prepare reports detailing claim status, payments, and reserves • Compute disability rates according to state laws • Coordinate timely communications with clients, claimants, and other parties • Prepare newsletter articles as requested • Provide qualifying-claim notices to excess/reinsurance carriers • Handle complex claims with minimal supervision • Conduct claim reviews and training sessions for designated clients • Attend and participate in hearings, mediations, and informal legal conferences • Comply with corporate claim-handling standards and client-specific instructions • Support clients' risk management needs through customized claim solutions and technology

🎯 Requirements

• 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 preferred • Litigation management experience preferred • Black Lung claims experience preferred • Experience supporting dedicated claim programs preferred • Prior TPA experience preferred • Professional designations such as AIC, CPCU, ARM, or WCP preferred • Visa sponsorship is not provided

🏖️ Benefits

• 4 weeks paid time off • 10 paid holidays in your first year • Medical insurance • Dental insurance • Vision insurance • Life insurance • Disability insurance • 401(k) • Employee Stock Ownership Plan (ESOP) • Internal training and advancement opportunities • Supportive, team-based work environment • Bonuses or additional forms of pay may be available