Senior Workers’ Comp Adjuster-Large Loss Claims Specialist
- Philadelphia, PA
- $59,681-96,123 per year
- Permanent
- Full-time
- Claim Management
- Handle a caseload of large loss and catastrophic workers’ compensation claims, including complex medical and indemnity exposures
- Investigate claims thoroughly to determine compensability, cause, extent of injuries, and potential for subrogation or fraud.
- Establish and maintain accurate reserves based on file exposure and claim progression.
- Develop, document, and execute claims strategies tailored to each file.
- Communication & Coordination
- Serve as the primary point of contact for all parties involved in the claim, including injured workers, employers, medical providers, attorneys, and internal teams.
- Provide regular status updates to stakeholders, ensuring transparency and alignment with claim objectives.
- Collaborate with internal resources such as nurse case managers, vocational experts, and legal counsel to drive claim resolution.
- Compliance & Documentation
- Ensure claims are managed in accordance with applicable workers’ compensation laws, jurisdictional requirements, and internal guidelines.
- Maintain complete, organized, and timely claim documentation within the claims management system.
- Prepare required carrier reports, correspondence, and settlement recommendations.
- Litigation Management
- Direct and oversee litigation strategy on contested claims, including selection and oversight of defense counsel.
- Attend mediations, hearings, and settlement conferences as needed.
- Financial & Strategic Impact
- Identify opportunities to control claim costs through proactive management and early intervention.
- Monitor and manage large loss exposures to protect company assets.
- Participate in file reviews and provide insight into loss trends, reserving practices, and improvement opportunities.
- In-depth knowledge of workers’ compensation laws, medical terminology, and claims best practices.
- Exceptional negotiation, communication, and interpersonal skills.
- Strong analytical, decision-making, and problem-solving abilities.
- Ability to manage multiple priorities in a fast-paced environment.
- Proficiency with claims management systems and Microsoft Office Suite.
- Education: Bachelor’s degree preferred; equivalent work experience considered.
- Experience:
- Minimum 5–7 years of workers’ compensation claims handling experience, with at least 3 years handling large loss/catastrophic claims.
- Multi-jurisdictional experience strongly preferred.