Senior Claims Specialist - Workers Compensation

Great American Insurance Group•PA Work At Home, DE

22h•$95,000 - $110,000•Remote

About The Position

Great American Insurance Group’s Strategic Comp business is seeking an experienced Senior Claims Specialist to manage Pennsylvania and Delaware workers’ compensation claims from inception through resolution. The role involves investigating claims, evaluating coverage and compensability, determining benefits eligibility, establishing reserves, negotiating settlements, and developing strategies for effective claim resolution. The position takes an aggressive, proactive approach to claim adjusting and focuses on outcomes. This is a remote position requiring work during Eastern Time Zone business hours, with occasional travel as needed. The specialist communicates with claimants, insureds, employers, and other stakeholders; works with defense counsel and external resources; and ensures compliance with Pennsylvania and Delaware workers’ compensation requirements.

Requirements

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.
Ability to work Eastern Time Zone business hours and travel occasionally as needed.
Strong written and verbal communication skills and the ability to work with a variety of internal and external contacts.
Delaware workers’ compensation license required.

Nice To Haves

Professional industry designations such as Associate in Claims (AIC).
Additional state licenses.

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.
Communicate regularly with claimants, insureds, employers, and other stakeholders.
Prepare and present large loss reports to internal and external audiences.
Collaborate with defense counsel on litigation strategy and claim resolution.
Partner with medical case managers, surveillance vendors, and other external resources.
Ensure compliance with Pennsylvania and Delaware workers' compensation laws and regulations.
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.