PA Workers' Compensation Medical Only Adjuster (Remote)

Ccmsi • Pittsburgh, PA

6d • Remote

About The Position

The Medical Only Claim Representative is responsible for the handling and administration of Pennsylvania Workers' Compensation medical-only claims within a dedicated carrier program. This role manages a high-volume inventory of claims while ensuring timely, accurate, and compliant claim handling. Working closely with claim staff and internal business partners, the Medical Only Claim Representative supports the claim process from initial assignment through closure by coordinating medical treatment, reviewing documentation, managing claim activity, and maintaining accurate claim records. This position is ideal for individuals who have workers' compensation experience, strong organizational skills, and an interest in growing their claims career. It offers valuable exposure to claim handling while developing the technical knowledge needed for advancement into more complex adjusting roles.

Requirements

• Associate degree or two years of related business, insurance, healthcare, claims, customer service, or administrative experience
• Knowledge of Pennsylvania Workers' Compensation claims or workers' compensation processes
• Strong attention to detail and organization skills
• Ability to manage a high-volume workload efficiently and accurately
• Strong written and verbal communication skills
• Ability to prioritize multiple tasks and deadlines
• Proficiency with Microsoft Office applications including: Outlook Word Excel
• Ability to work independently in a remote environment
• Reliable attendance during established business hours

Nice To Haves

• Prior Pennsylvania Workers' Compensation experience
• Medical-only claim handling experience
• Carrier or TPA claim experience
• Knowledge of medical terminology
• Experience reviewing medical bills, treatment records, and claim documentation
• Experience working within a dedicated client or carrier program
• Interest in developing a long-term career in Workers' Compensation claims
• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.

Responsibilities

• Manage Pennsylvania Workers' Compensation medical-only claims from assignment through closure
• Review claim information and supporting documentation to ensure accurate claim setup and handling
• Coordinate and monitor medical treatment activities in accordance with claim handling standards
• Review and process medical bills, invoices, and claim-related documentation
• Maintain timely diary management and claim file documentation
• Summarize medical records, correspondence, and claim activities within the claim system
• Communicate with medical providers, employers, and internal claim partners as needed
• Monitor claim activity and identify opportunities for closure or escalation
• Assist claim staff with claim support activities and special projects
• Maintain compliance with Pennsylvania Workers' Compensation regulations, Corporate Claim Standards, and client-specific handling instructions
• Provide responsive service and support while maintaining quality and productivity expectations

Benefits

• 4 weeks (Paid time off that accrues throughout the year in accordance with company policy) + 10 paid holidays in your first year
• Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance
• Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP)
• Career growth: Internal training and advancement opportunities
• Culture: A supportive, team-based work environment

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree