[Hiring] Medical Only Claims Adjuster @Ccmsi

Role Description

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.

• 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

• 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, and Excel
• Ability to work independently in a remote environment
• Reliable attendance during established business hours

Requirements

• Prior Pennsylvania Workers' Compensation experience (nice to have)
• Medical-only claim handling experience (nice to have)
• Carrier or TPA claim experience (nice to have)
• Knowledge of medical terminology (nice to have)
• Experience reviewing medical bills, treatment records, and claim documentation (nice to have)
• Experience working within a dedicated client or carrier program (nice to have)
• Interest in developing a long-term career in Workers' Compensation claims (nice to have)
• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required (nice to have)

Benefits

• 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