Workers Compensation Claims Specialist, Sr

New Jersey Manufacturers Insurance Company — Pittsburgh, Pennsylvania (remote, Western/Central PA residency required). Posted 10/17/2026. This is a 100% remote position with virtual claims handling across PA and possibly MD, DE, or CT. Hours: Monday–Friday, 8:00 AM–4:15 PM (start time may vary). Training required at the NJM West Trenton office. Travel approximately 2–3 days per week for on-site policyholder/agent meetings.

About the role

NJM's WC Claims Department empowers employees to deliver guidance and empathy to customers. The department is driven by service and customer advocacy, providing transparent, empathetic support and collaborative engagement throughout the life of a claim. Specialists are supported by a dedicated call center and specialized units (reserves, permanency payments, subrogation) so they can focus on managing claims. The team is long-tenured and relationship-focused, fostering a positive, nurturing work environment.

Responsibilities

• Ensure quality management of claims in accordance with best practices and company guidelines, with timely, accurate documentation of claim activity
• Provide a high level of customer service that promotes injured-worker advocacy-based principles to improve outcomes for all parties
• Determine compensability and coverage issues by gathering medical and factual evidence
• Administer the delivery of timely, appropriate, and accurate benefits
• Evaluate claims for potential fraud indicators and escalate to SIU as appropriate
• Recognize and investigate subrogation opportunities and refer to NJM subrogation staff for recovery of third-party funds
• Initiate and provide excellent communication with all stakeholders (injured workers, medical providers, attorneys, policyholders, agents, etc.) professionally and proactively with a customer-centric approach
• Apply critical thinking skills to evaluate and mitigate exposures, and establish and implement a proactive strategic plan of action
• Assign and refer claim petitions to Counsel, and work to resolve claims within given authority
• Build rapport with policyholders and agents, conduct on-site investigations when necessary, and educate policyholders and agents on NJM procedures, policies, and claim practices
• Prepare and attend Claim Reviews at policyholder or agent locations in Western and/or Central PA or virtually for further locations
• Serve as a liaison between policyholders/agents and various departments in NJM
• Represent WC Claims in on-site capabilities meetings to onboard new policyholders in Western and/or Central PA
• Participate in training programs to stay current on relevant issues/topics
• Recommend process improvements to enhance department efficiency, work product, and service commitment
• Demonstrate commitment to NJM's Code of Business Conduct and Ethics, and apply knowledge of compliance policies, procedures, standards, and laws applicable to job responsibilities

Requirements

• 5+ years' experience as a Workers' Comp Claim Representative, or comparable knowledge and experience with various aspects of claims handling/process including advanced knowledge of medical terminology and WC regulations for PA, MD, and/or DE claims
• Knowledge of and/or experience working with liens and Medicare Set-Asides to secure full and final settlements
• Customer-service oriented with strong written and oral communication skills
• Strong interpersonal skills with ability to work both in a team and independently
• Demonstrated organizational skills and sound decision-making capabilities
• Working knowledge utilizing an automated claim processing system and Microsoft Office tools including Word and Outlook
• Licensed in DE and/or CT to adjust WC claims, or ability to obtain these licenses within 90 days
• Ability to travel for business purposes, approximately 2–3 days a week meeting with policyholders and/or agents

Preferred Qualifications

• Associate or bachelor's degree
• AIC/CPCU or other applicable insurance designations
• Experience using Guidewire Claim Center, OnBase, and additional Microsoft Office tools including Teams, Excel, and PowerPoint
• Knowledge and experience in claims handling for other commercial line products in various states including PA, MD, and/or DE

Pay

Senior-level starting rate: $79,129.05+ annually based on experience and credentials. Pay range: $79,129–$91,834.

Benefits

Eligible full-time employees receive a competitive Total Rewards package including but not limited to: 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; paid parental leave in addition to state-mandated leave; and potential eligibility for discretionary bonuses.