Senior Workers Compensation Claims Specialist

Title : Senior Workers Compensation Claims Specialist
Location : Remote | candidates must reside in Western or Central PA with the ability to travel to Trenton, NJ for training
Job Type : Permanent/Direct-Hire
Compensation : $79,000 - $90,000 per year
Industry: Insurance

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About the Role
Our firm is partnering with a well-established regional property and casualty insurance organization to identify an experienced Senior Workers’ Compensation Claims Specialist . This role supports policyholders and agents throughout Western and Central Pennsylvania, providing high-touch, advocacy-based claims service. While the position is fully remote, it includes regional travel and on-site engagement with policyholders, agents, and stakeholders. Initial training is conducted onsite at the client’s New Jersey office.
The Workers’ Compensation Claims team is service-driven and customer-focused, emphasizing transparency, empathy, and collaboration throughout the life of a claim. Claims professionals are supported by a dedicated call center and specialized internal units, allowing them to focus on strategic claim management, relationship-building, and optimal outcomes for injured workers and employers. Job Description

• Manage workers’ compensation claims in accordance with best practices, regulatory requirements, and internal guidelines, ensuring timely and accurate documentation
• Deliver high-quality customer service rooted in injured worker advocacy to improve outcomes for all parties
• Determine compensability and coverage by gathering and analyzing medical and factual evidence
• Administer timely, appropriate, and accurate benefit delivery
• Identify potential fraud indicators and escalate claims to Special Investigation Units as appropriate
• Recognize and investigate subrogation opportunities and coordinate referrals for third-party recovery
• Communicate proactively and professionally with injured workers, medical providers, attorneys, policyholders, and agents
• Apply critical thinking to evaluate exposures and develop proactive claim resolution strategies
• Assign claim petitions to legal counsel and work toward resolution within designated authority levels
• Build strong relationships with policyholders and agents, including conducting on-site investigations when needed
• Educate policyholders and agents on claims procedures, policies, and best practices
• Prepare for and participate in claim reviews at policyholder or agent locations in Western and/or Central Pennsylvania, or virtually as needed
• Serve as a liaison between policyholders, agents, and internal departments
• Represent workers’ compensation claims during onboarding and capability meetings for new policyholders
• Participate in ongoing training to remain current on regulatory, medical, and industry developments
• Recommend process improvements to enhance efficiency, service quality, and departmental performance
• Adhere to all compliance standards, ethical guidelines, and applicable laws related to claims handling

Qualifications
Required

• 5+ years of experience as a Workers’ Compensation Claims Representative or equivalent experience handling complex WC claims
• Advanced knowledge of medical terminology and workers’ compensation regulations for Pennsylvania, Maryland, and/or Delaware
• Experience working with liens and Medicare Set-Asides to support full and final settlements
• Strong customer service orientation with excellent written and verbal communication skills
• Proven ability to work independently and collaboratively in a team environment
• Strong organizational, analytical, and decision-making skills
• Experience using automated claims processing systems and Microsoft Office tools (Word, Outlook)
• Active workers’ compensation adjuster license in Delaware and/or Connecticut, or ability to obtain required licenses within 90 days
• Ability to travel for business purposes approximately 2–3 days per week to meet with policyholders and agents

Preferred

• Associate’s or bachelor’s degree
• Insurance designations such as AIC, CPCU, or similar
• Experience with Guidewire ClaimCenter, OnBase, and Microsoft Teams, Excel, and PowerPoint
• Experience handling other commercial lines claims across multiple states, including Pennsylvania, Maryland, and/or Delaware

Benefits
Eligible full-time employees receive a competitive Total Rewards package, including but not limited to a 401(k) with employer match up to 8% and additional service-based contributions, Health, Dental, and Vision insurance, Life and Disability coverage, generous PTO, Paid Sick Leave, and paid parental leave in addition to state-mandated leave. Employees may also be eligible for discretionary bonuses. How to Apply
Take the first step on your new career path! To submit yourself for consideration for this role, simply click the apply button and complete our mobile-friendly online application. Once we’ve reviewed your application details, a recruiter will reach out to you with next steps! Equal Opportunity Statement
As an equal opportunity employer, Dahl Consulting welcomes candidates of all backgrounds and experiences to apply. If this position sounds like the right opportunity for you, we encourage you to take the next step and connect with us. We look forward to meeting you.;
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