Complex Claims Adjuster Jobs Near Me

Overview

Workers' Compensation Claim Consultant - Pennsylvania

Location: RemoteSchedule: Monday - Friday, 8:00 AM - 4:30 PM ESTSalary Range: $65,000 - $85,000 annually

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 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.

Responsibilities

When we hire Workers' Compensation Adjusters at CCMSI, we look for detaildriven problemsolvers who balance empathy with sound judgment, navigate complex regulations with confidence, and deliver fair, timely outcomes that support injured workers and strengthen client trust.

• 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.

QualificationsRequired Qualifications

• 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

Preferred Qualifications

• 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

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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