Remote Claim Processor Jobs in Pittsburgh, PA (NOW HIRING)

Overview
Claim Representative, Medical Only - Pennsylvania Workers' Compensation
Location: Remote
Schedule: Monday-Friday, 8:00am - 4:30pm EST
Salary Range: $45,000 - $55,000 annually, paid hourly (37.5 hours per week)
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.
Job Summary
The Medical Only Claim Representative is responsible for the handling and administration of Pennsylvania Workers' Compensation medical-only claims within a dedicated carrier program. This role manages a high-volume inventory of claims while ensuring timely, accurate, and compliant claim handling.
Working closely with claim staff and internal business partners, the Medical Only Claim Representative supports the claim process from initial assignment through closure by coordinating medical treatment, reviewing documentation, managing claim activity, and maintaining accurate claim records.
This position is ideal for individuals who have workers' compensation experience, strong organizational skills, and an interest in growing their claims career. It offers valuable exposure to claim handling while developing the technical knowledge needed for advancement into more complex adjusting roles.
Responsibilities
When we hire claim reps at CCMSI, we look for detail oriented professionals who understand that every task supports a real person's claim experience, value accuracy and responsiveness, and contribute to the team's success through organization, collaboration, and a strong commitment to service.

• Manage Pennsylvania Workers' Compensation medical-only claims from assignment through closure

• Review claim information and supporting documentation to ensure accurate claim setup and handling

• Coordinate and monitor medical treatment activities in accordance with claim handling standards

• Review and process medical bills, invoices, and claim-related documentation

• Maintain timely diary management and claim file documentation

• Summarize medical records, correspondence, and claim activities within the claim system

• Communicate with medical providers, employers, and internal claim partners as needed

• Monitor claim activity and identify opportunities for closure or escalation

• Assist claim staff with claim support activities and special projects

• Maintain compliance with Pennsylvania Workers' Compensation regulations, Corporate Claim Standards, and client-specific handling instructions

• Provide responsive service and support while maintaining quality and productivity expectations

Qualifications
Required:

• Associate degree or two years of related business, insurance, healthcare, claims, customer service, or administrative experience

• Knowledge of Pennsylvania Workers' Compensation claims or workers' compensation processes

• Strong attention to detail and organization skills

• Ability to manage a high-volume workload efficiently and accurately

• Strong written and verbal communication skills

• Ability to prioritize multiple tasks and deadlines

• Proficiency with Microsoft Office applications including:
  • Outlook
  • Word
  • Excel

• Ability to work independently in a remote environment

• Reliable attendance during established business hours

Nice to Have:

• Prior Pennsylvania Workers' Compensation experience

• Medical-only claim handling experience

• Carrier or TPA claim experience

• Knowledge of medical terminology

• Experience reviewing medical bills, treatment records, and claim documentation

• Experience working within a dedicated client or carrier program

• Interest in developing a long-term career in Workers' Compensation claims

• Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, or vendors, but not required.
Why You'll Love Working Here
• 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
How We Measure Success
At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by:
• Quality claim handling - thorough investigations, strong documentation, well-supported decisions
• Compliance & audit performance - adherence to jurisdictional and client standards
• Timeliness & accuracy - purposeful file movement and dependable execution
• Client partnership - proactive communication and strong follow-through
• Professional judgment - owning outcomes and solving problems with integrity
• Cultural alignment - believing every claim represents a real person and acting accordingly
This is where we shine, and we hire adjusters who want to shine with us.
Compensation & Compliance
The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.
CCMSI offers comprehensive benefits including medical, dental, vision, life, and disability insurance. Paid time off accrues throughout the year in accordance with company policy, with paid holidays and eligibility for retirement programs in accordance with plan documents.
Visa Sponsorship: CCMSI does not provide visa sponsorship for this position.
ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process.
Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations.
Background checks, if required for the role, are conducted only after a conditional offer and in accordance with applicable fair chance hiring laws.
Our Core Values
At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who:

• Lead with transparency We build trust by being open and listening intently in every interaction.
• Perform with integrity We choose the right path, even when it is hard.
• Chase excellence We set the bar high and measure our success. What gets measured gets done.
• Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own.
• Win together Our greatest victories come when our clients succeed.

We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you.
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