Sr. Workers' Compensation Claims Examiner

2 days ago

Philadelphia, Pennsylvania, United States King's Insurance Staffing Full time

Our client, an 'A' rated Insurance Carrier, is currently seeking an experienced Senior Workers' Compensation Claims Examiner with a proven track record in managing moderate to complex claims in Pennsylvania. This role requires a professional with experience in workers' compensation claims, who is adept at handling complex litigated and non-litigated Pennsylvania Lost Time with a focus on quality and efficiency. This is a fully remote position with the ideal candidate residing in PA or NJ.

Key Responsibilities:

  • Responsible for handling a caseload of Lost Time Pennsylvania Workers' Compensation claims from inception to close.
  • Negotiate settlements and authorize payments within delegated limits.
  • Ensure compliance with all state regulatory requirements and internal policies.
  • Communicate effectively with policyholders, medical professionals, employers, and legal counsel to gather information and resolve claims.
  • Maintain accurate records and prepare reports for management regarding claim status and resolution.
  • Attend hearings, mediations, and other legal proceedings as required.
  • Provide guidance and training to junior claims staff and support their development.

Qualifications:

  • 5+ years of experience as a Workers' Compensation Claims Examiner with a deep understanding of Pennsylvania Workers' Compensation Law
  • Experience and strong knowledge in New Jersey Workers' Compensation Law is a plus
  • Strong understanding of Pennsylvania EDI processes and transactions.
  • Effective organizational skills and ability to work independently
  • Bachelor's degree in Business, Insurance, or a related field preferred.

Salary/Benefits:

  • $95,000 to $110,000+ base salary plus Annual Bonus
  • Employer matching 401(k) plan
  • Extremely competitive Medical, Dental, Vision and Life plans
  • Employer Contribution to HSA
  • Generous PTO
  • Flexible work schedule and ability to work from home

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