Medical Claims Processor - In Office!

Great American Insurance Group; Pennsylvania; Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

401(k) with company match

Commuter benefits

Paid time off

Job summary

Great American Insurance Group seeks an experienced Senior Claims Specialist to manage Pennsylvania and Delaware workers' compensation claims, from inception to resolution. You will analyze claims, develop strategies, and negotiate settlements while coordinating with defense counsel and medical teams.

The role is remote with Eastern Time Zone business hours, offering collaboration with a national team and opportunities to grow expertise in workers' compensation across PA and DE.

Qualifications

• 10+ years of PA/DE workers' compensation claims adjusting experience.
• Strong knowledge of PA/DE workers' comp laws, regulations, and practices.
• Ability to work Eastern Time Zone business hours with occasional travel.

Responsibilities

• Manage Pennsylvania and Delaware workers' compensation claims from inception through resolution.
• Analyze claim facts and evaluate coverage, compensability, and benefits eligibility.
• Develop and execute strategies to achieve timely and favorable claim outcomes.
• Establish and maintain appropriate claim reserves.
• Negotiate settlements and bring about claim resolution.
• Collaborate with defense counsel on litigation strategy and claim resolution.
• Partner with medical case managers, surveillance vendors, and other external resources.
• Maintain accurate and timely claim documentation.
• Analyze claim trends and exposure to support effective decision-making.
• Provide exceptional service while building strong relationships with customers and business partners.

Skills

Workers' comp claims

PA/DE laws

AIC designation

Remote work

Eastern Time hours

Education

Associate in Claims (AIC) designation

Job description

Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group's member companies are subsidiaries of American Financial Group. We combine a "small company" culture where your ideas will be heard with "big company" expertise to help you succeed. With over 30 specialty and property and casualty operations, there are always opportunities here to learn and grow. Strategic Comp is a leading provider of workers' compensation insurance for large employers committed to protecting their workforce. As part of Great American Insurance Group, we combine the strength and stability of a trusted organization with more than 150 years of history with the entrepreneurial spirit of a growing business.

Through our specialized insurance expertise and field-based service model, we build lasting partnerships and deliver exceptional results for our customers. Our culture is built on collaboration, excellence, and a shared commitment to serving our customers and one another.

Strategic Comp is seeking an experienced Senior Claims Specialist to manage Pennsylvania and Delaware workers' compensation claims. This role is responsible for investigating claims, determining compensability, establishing reserves, negotiating settlements, and developing strategies that drive effective claim resolution.

We take an extremely aggressive and proactive approach to claim adjusting and are looking for the person who not only knows their jurisdiction’s comp laws but also enjoys the role of putting that experience to good use. Because we focus on outcomes and not just processes, we look for an adjuster who is very skilled at developing strategies to bring claims to resolution. This is a remote position that requires working Eastern Time Zone business hours.

• Manage Pennsylvania and Delaware workers' compensation claims from inception through resolution.
• Analyze claim facts and evaluate coverage, compensability, and benefits eligibility.
• Develop and execute strategies to achieve timely and favorable claim outcomes.
• Establish and maintain appropriate claim reserves.
• Negotiate settlements and bring about claim resolution.
• Collaborate with defense counsel on litigation strategy and claim resolution.
• Partner with medical case managers, surveillance vendors, and other external resources.
• Maintain accurate and timely claim documentation.
• Analyze claim trends and exposure to support effective decision-making.
• Provide exceptional service while building strong relationships with customers and business partners.

• 10+ years of Pennsylvania and Delaware workers' compensation claims adjusting experience, including complex or high-exposure claims.
• Strong knowledge of Pennsylvania and Delaware workers' compensation laws, regulations, and claims practices.
• Professional industry designations such as Associate in Claims (AIC) are preferred.
• Ability to work Eastern Time Zone business hours and travel occasionally as needed.

Business Unit:

• We offer competitive benefits packages for full-time and part-time employees*. Full-time employees have access to medical, dental, and vision coverage, wellness plans, parental leave, adoption assistance, and tuition reimbursement.
• Full-time and eligible part-time employees also enjoy Paid Time Off and paid holidays, a 401(k) plan with company match, an employee stock purchase plan, and commuter benefits.

Excludes seasonal employees and interns.