CCMSI · 15 hours ago
Workers' Compensation Claim Adjuster, Sr. (CA Claims - Remote)
United States
Full-time
Remote
Senior Level, Lead/Staff
$87K/yr - $97K/yr
15+ years expCCMSI is a leading Third Party Administrator specializing in risk management solutions. The Senior Workers’ Compensation Claim Specialist is responsible for managing the investigation and resolution of assigned workers’ compensation claims while ensuring high-quality claims services that meet corporate standards and client expectations.
Financial ServicesInsuranceRetail
No H1B
Responsibilities
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.)
Review and maintain personal diary on claim system
Assess and monitor subrogation claims for resolution
Compute disability rates in accordance with state laws
Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the claim adjustment process
Provide notices of qualifying claims to excess/reinsurance carriers
Compliance with Corporate Claim Handling Standards and special client handling instructions as established
Qualification
Required
Strong oral and written communication skills
15 years of works' compensation claim adjusting
Effective analytical and negotiation skills
Ability to set and achieve performance goals with initiative
Effective analytical and negotiation skills
Ability to manage multiple client accounts and competing priorities
Comprehensive knowledge of lower-level claims role responsibilities
Experience adjusting lost-time claims and managing litigated files
Detail-oriented, self-motivated, and highly organized
Ability to coordinate, prioritize, and work with minimal supervision
Flexible, accurate, and proactive approach to work
Commitment to discretion and confidentiality
Reliable and predictable attendance during client service hours
Responsive to internal and external client needs
Ability to communicate clearly and professionally in verbal and written formats
Proficiency in Microsoft Office (Word, Excel, Outlook)
California jurisdiction experience required
Preferred
California SIP certification
Claim review presentation experience
AIC, ARM, or CPCU designation
Benefits
4 weeks PTO + 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
Company
CCMSI
CCMSI is a third-party administrator for workers' compensation and property/casualty self-insurance programs.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
G
G. Bryan G. Bryan Thomas
President/CEO
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