Job Title: Workers’ Compensation Indemnity Specialist
RESPONSIBILITIES:
We are seeking an experienced Indemnity Claims Specialist to manage a complex workers’ compensation desk with a strong emphasis on Pennsylvania lost-time and litigated claims. This role handles primarily indemnity and complex files, with limited medical-only exposure, and requires collaboration with internal leadership and external stakeholders to ensure high-quality, compliant claim outcomes.
- Manage a caseload of approximately 135 open indemnity and complex workers’ compensation claims, including lost-time files
- Handle a desk that is at least 50% litigated, working closely with defense attorneys
- Demonstrate strong working knowledge of Pennsylvania Workers’ Compensation regulations and practices
- Apply New Jersey and Delaware jurisdictional knowledge as required by assigned files
- Investigate claims, determine compensability, establish reserves, and manage ongoing exposur
- Coordinate medical care, wage loss benefits, and return-to-work efforts
- Communicate effectively with all stakeholders, including attorneys, injured workers, employers, carriers, and medical providers
- Utilize claims management systems to document activity, manage workflows, and meet service expectations
- Adhere to quality standards, production benchmarks, and client service level agreements (SLAs)
- Participate in internal reviews, audits, and performance evaluations
Performance Measures
- Compliance with quality and accuracy standards
- Meeting production expectations for claim handling and resolution
- Adherence to client service level agreements (SLAs)
Stakeholders
- External: Defense attorneys, injured workers, employers, clients, carriers, medical providers
- Internal: Supervisor, Manager, Account Manager
QUALIFICATIONS:
Experience & Knowledge
- 2–3 years of workers’ compensation claims experience, with a strong focus on indemnity and lost-time claims
- Extensive Pennsylvania workers’ compensation experience required
- New Jersey claims experience required
- Delaware experience preferred and may be eligible for additional consideration
- Prior experience handling litigated claims is required
Licenses & Education
- Delaware Adjuster’s License required
- Assistance available to obtain license within 120 days, if not currently held
- Reciprocal licenses (Florida or Texas) accepted
- Bachelor’s degree or equivalent relevant work experience
Technical Skills
- Proficiency in Microsoft Office (Teams, Outlook/Email, Word)
- Experience using CareMC claims system preferred (not required)
- Strong documentation, organization, and time-management skills
Compensation & Benefits
- Base Salary: $80,000
- Annual Adjuster Bonus: Up to 4%, eligible beginning in 2027 (based on July 1 eligibility cutoff)
- Paid Time Off: Standard 2 weeks of vacation
- Comprehensive benefits package including medical, dental, vision, and retirement options
OpTech is an equal opportunity employer and is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, status as a parent, disability, age, veteran status, or other characteristics as defined by federal, state or local laws. https://www.optechus.com/eeo_self_identification/