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Workers' Compensation Claim Adjuster
4 months ago
Overview:
At CCMSI, we look for the best and brightest talent to join our team of professionals.
As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients.
As an Employee-Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts.
Certified as a Great Place To Work, our employee satisfaction and retention ranks in the 95th percentile.Reasons you should consider a career with CCMSI:
Culture:
Our Core Values are embedded into our culture of how we treat our employees as a valued partner-with integrity, passion and enthusiasm.
Career development:
CCMSI offers robust internships and internal training programs for advancement within our organization.
Benefits:
Not only do our benefits include 4 weeks paid time off in your first year, plus 10 paid holidays, but they also include Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP.
Work Environment:
We believe in providing an environment where employees enjoy coming to work every day, are provided the resources needed to perform their job and claims staff are assigned manageable caseloads.
We are seeking a Workers' Compensation Claim Adjuster I to join our team. This position offers a hybrid schedule with 2 days in the office and 3 days working from home. An active NM WC Adjuster license is required or must be obtained within the first 60 days of employment. Experience in Workers' Compensation claims handling is preferred, along with knowledge of medical terminology.As a Workers' Compensation Claim Adjuster I, you will be responsible for investigating and adjusting assigned workers' compensation claims.
This role may serve as an advanced training opportunity for potential promotion to a Work Comp Claim Rep II or higher-level claim position in the future.
Key responsibilities include maintaining high standards of claim service quality as perceived by CCMSI clients and in accordance with our corporate claim standards.
Responsibilities:
Investigate and adjust workers compensation claims in accordance with established claims handling procedures using CCMSI guidelines and direct supervision.
Review medical, legal and miscellaneous invoices to determine if reasonable and related to the ongoing workers compensation claims. Negotiate any disputed bills for resolution.
Authorize and make payment of workers compensation claims utilizing a claim payment program in accordance with industry standards and within settlement authority.
Assist in selection and supervision of defense attorneys.
Assess and monitor subrogation claims for resolution.
Prepare reports detailing claims, payments and reserves.
Provide reports and monitor files, as required by excess insurers.
Compliance with Service Commitments as established by team.
Delivery of quality claim service to clients.
Performs other duties as assigned.
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Excellent oral and written communication skills.
Individual must be a self-starter with strong organizational abilities.
Ability to coordinate and prioritize required.
Flexibility, initiative, and the ability to work with a minimum of direct supervision a must.
Discretion and confidentiality required.
Ability to work as a team member in a rapidly changing environment.
Reliable, predictable attendance within client service hours for the performance of this position.
Responsive to internal and external client needs.
Ability to clearly communicate verbally and/or in writing both internally and externally.
Education and/or Experience
1 or more years of workers compensation claim experience or other related industry experience is required.
Associates degree is preferred.
Computer Skills
Proficient using Microsoft Office programs such as: Word, Excel, Outlook, etc.
Certificates, Licenses, Registrations
New Mexico Workers' Compensation Claim Adjuster license is preferred.
CORE VALUES & PRINCIPLES
Responsible for upholding the CCMSI Core Values & Principles which include: performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity; insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better; and leading by example.
CCMSI is an Affirmative Action / Equal Employment Opportunity employer offering an excellent benefit package including Medical, Dental, Prescription Drug, Vision, Flexible Spending, Life, ESOP and 401K.
