Job Description
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
Company DescriptionFamily-owned, highly communicative, and collaborative culture. Opportunities for advancement and paid training for certification.
Family-owned, highly communicative, and collaborative culture. Opportunities for advancement and paid training for certification.
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