Workers Compensation Claims Manager Jobs in Pennsylvania

Experience applying laws, rules, regulations, policies, and procedures when reviewing claims for benefits

Experience adjudicating highly complex cases for benefits based on evidence.

Experience reviewing reconsideration requests or appeals for benefits.

Requires a probationary period if the requirement has not been met.

Experience making and issuing final decisions that affirm or remand cases for further development

Reviews claimant requests for reconsideration of final decisions with delegated authority to finalize or modify decisions of the initial claims examiner.

Apply your examiner, knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.

A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

Professional certification as applicable to line of business preferred.

Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.

Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.

Exceptional communication skills including the ability to develop and present clear and concise analysis and recommendations to senior management

Strong ability to engage/interact with leadership, writing and analysis skills, and autonomous/self-starter

Excellent written and verbal communication skills

One of the current certifications (CPC, CHC, CCS, CCS-P, CIC, COC, CRC, CPMA, RHIT, RHIA) strongly preferred

Ten years of experience including at least 5 years working/supervising in a claims department is required

Medical, Dental, & Vision benefits with employer contribution (pre-taxable savings)

Determine need for and provide direction to defense counsel, nurse case managers or other technical experts. Pursue subrogation when necessary.

Ensure data submitted is accurate, timely, and in compliance with all requirements.

Support workflow in a remote capacity, if applicable. The methods may vary based on work location of assigned Claims Consultant.

5+ years’ experience adjusting Workers’ Compensation lost time claims.

Solid technical knowledge of Workers’ Compensation laws for Pennsylvania.

Strong verbal and written communication skills.

Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU).

Manages an inventory of claims to evaluate compensability/liability.

BS/BA degree or equivalent work experience.

Minimum of 1-2 years experience in claims adjustment, general insurance or formal claims training.

Knowledge of claims investigation techniques, medical terminology and legal aspects of claims preferred.

Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources.

Previous medical case management experience a plus.

Strong communication skills in order to build relationships with injured employees, medical professionals, employers, field claims staff and others.

Good negotiation skills to effectively establish target return to work dates and coordinate medical care.

Knowledge of state, local and federal laws related to health care delivery preferred.

Personal computer knowledge and proficiency in general computer applications such as Internet Explorer and Microsoft Office (including Word, Excel and Outlook).

Must have additional professional certifications, such as CCM, COHN, CRRN, etc., where required by WC law.

2 years of direct team lead, supervisory or management experience.

Proactively identifies opportunities to improve operational effectiveness, member experiences and processes providing feedback to internal partners

Facilitates and guides employees through skill identification and developing for career progression Supports projects by serving as a subject matter expert.

Identifies and manages existing and emerging risks that stem from business activities and the job role.

Experience using and interpreting data to make decisions.

Demonstrated leadership, initiative, customer service and/or claims handling skills.