Workers Compensation Claims Examiner

SDI Staffing; Philadelphia (Philadelphia County); Hybrid; USD 85,000 - 95,000; Full time

Benefits offered by this job

Full comprehensive benefits package

Medical, dental, vision insurance

Paid Time Off (PTO)

Job summary

SDI Staffing is seeking an experienced Workers' Compensation Claims Examiner to join a well-established organization in the insurance industry. The ideal candidate will manage a caseload of complex claims and ensure compliance with state regulations.

This full-time position offers a hybrid work model, with comprehensive benefits, and requires strong analytical and communication skills. A Bachelor's degree and 3+ years of experience in claims handling are preferred.

Qualifications

• Bachelor's degree in a related field preferred.
• Minimum of 3+ years of workers' compensation claims handling experience.
• Strong knowledge of Pennsylvania and New Jersey workers' compensation laws.

Responsibilities

• Manage a caseload of 125 to 150 workers' compensation claims.
• Handle claims from inception through conclusion per company guidelines.
• Investigate claims and determine compensability according to regulations.
• Negotiate, settle, and finalize claims obtaining proper settlement authority.

Skills

Workers' compensation claims management

Analytical skills

Communication skills

Organizational skills

Decision-making skills

Education

Bachelor's degree in a related field

Tools

Microsoft Word

Microsoft Excel

Job description

Our client, a well-established organization in the insurance industry, is seeking an experienced Workers' Compensation Claims Examiner to join their team. Candidates must reside in Philadelphia!

Hours

Full-Time

Duration

Direct Hire

Workplace

Hybrid: 3 days remote and 2 days in office

Pay

$85,000 to $95,000

Benefits

Full comprehensive benefits package including medical, dental, vision, and PTO.

Responsibilities

• Manage a caseload of 125 to 150 workers' compensation indemnity claims, including complex files.
• Handle workers' compensation claims from inception through conclusion within established authority and company guidelines.
• Investigate claims promptly and determine compensability in accordance with Pennsylvania and New Jersey workers' compensation laws.
• Administer indemnity benefits and manage medical treatment and medical billing.
• Refer claims to defense counsel and oversee litigation activities as appropriate.
• Communicate effectively with claimants, employers, medical providers, attorneys, vendors, and clients regarding claim status and resolution.
• Establish and maintain appropriate claim reserves within company authority guidelines.
• Negotiate, settle, and finalize claims while obtaining proper settlement authority.
• Maintain accurate claim documentation and diary management to ensure timely follow-up and file handling.
• Provide clients with timely updates, including injury trends and safety-related concerns.
• Partner with loss control staff when appropriate to support claim resolution.
• Conduct independent file reviews while ensuring compliance with company policies and procedures.
• Perform other duties as assigned.

Qualifications

• Bachelor's degree in a related field preferred.
• Minimum of 3+ years of workers' compensation claims handling experience or an equivalent combination of education and experience.
• Experience handling Pennsylvania and New Jersey workers' compensation claims is preferred.
• Strong knowledge of workers' compensation statutes, regulations, and medical terminology.
• Ability to independently manage a high-volume, complex workers' compensation caseload.
• Strong analytical, organizational, and decision-making skills.
• Excellent verbal and written communication skills with the ability to explain technical claim information clearly.
• Ability to build and maintain professional relationships with clients, claimants, attorneys, medical providers, and internal staff.
• Proficiency in Microsoft Word and Excel is preferred.
• Ability to work independently while managing multiple priorities in a fast-paced environment.