Pennsylvania Workers' Compensation Claims Adjuster (Remote)

Ccmsi • Pittsburgh, PA

3d • Remote

About The Position

Build Your Career With Purpose at CCMSI. At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success. We don’t just process claims—we support people. As the largest privately owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work®, and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day. The Workers' Compensation Claim Consultant is responsible for the investigation, evaluation, administration, and resolution of Pennsylvania Workers' Compensation claims from assignment through final closure. This role supports a dedicated carrier program and offers the opportunity to develop deep expertise within a single jurisdiction while building strong client and stakeholder relationships. The successful candidate will manage a caseload of claims ranging from moderate complexity to more complex exposures depending on experience and skill level. Claims may include litigated matters, ongoing medical management, indemnity benefits, return-to-work coordination, and settlement opportunities. This role is designed for experienced Pennsylvania Workers' Compensation adjusters who can independently manage a full inventory, exercise sound judgment, communicate effectively with all parties, and consistently deliver high-quality claim outcomes.

Requirements

• 5+ years of Pennsylvania Workers' Compensation claims handling experience
• Experience managing claims from investigation through closure
• Strong knowledge of Pennsylvania Workers' Compensation laws and claim handling practices
• Experience handling indemnity claims
• Experience establishing reserves and evaluating claim exposure
• Ability to independently manage a full caseload
• Strong written and verbal communication skills
• Effective negotiation and problem-solving abilities
• Strong organizational, diary management, and time-management skills
• Ability to work independently in a remote environment
• Proficiency with Microsoft Office applications, including Outlook, Word, and Excel
• Reliable attendance during established business hours

Nice To Haves

• Carrier claims experience
• Litigation management experience
• Black Lung claims experience
• Experience supporting dedicated claim programs
• Prior TPA experience
• Professional designations such as: AIC CPCU ARM WCP

Responsibilities

• Investigate, evaluate and adjust claims in accordance with established claim handling standards and laws.
• Establish reserves and/or provide reserve recommendations within established reserve authority levels.
• Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated claims.
• Negotiate any disputed bills or invoices for resolution.
• Authorize and make payments of claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.
• Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate.
• Assist in the selection, referral and supervision of designated claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.)
• Assess and monitor subrogation claims for resolution.
• Review and maintain personal diary on claim system.
• Client satisfaction.
• Prepare reports detailing claim status, payments and reserves, as requested.
• Compute disability rates in accordance with state laws.
• Effective and timely coordination of communication with clients, claimants and appropriate parties throughout the claim adjustment process.
• Prepare newsletter articles, as requested.
• Provide notices of qualifying claims to excess/reinsurance carriers.
• Handle more complex and involved claims than lower level claim positions with minimum supervision.
• Conduct claim reviews and/or training sessions for designated clients, as requested.
• Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.
• Compliance with Corporate Claim Handling Standards and special client handling instructions as established.

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: Mid Level
• Education Level: No Education Listed