Claims Specialist

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.
Pharmacy Liability Claims Adjuster - Multi-Line Claim Specialist

Location: Remote

About the Role:

We are seeking a seasoned Pharmacy Liability Claims Adjuster to join our team as a Multi-Line Claim Specialist. This role focuses on managing pharmacy liability claims for a national retail client. The ideal candidate will have a robust background in pharmacy liability claims, including experience with bodily injury (BI) claims and litigation.

Key Responsibilities:

Claims Management: Handle and adjust pharmacy liability claims with accuracy, including evaluating and negotiating settlements when liability is established.
Litigation Experience: Utilize your litigation experience to manage complex cases, working closely with legal teams and stakeholders to resolve disputes effectively.
Record Keeping: Maintain detailed records within our claims management system, ensuring compliance with industry standards and regulations.
Client Interaction: Provide exceptional customer service by managing client communications and documentation professionally.
High Standards: Uphold high standards of claim service in line with CCMSI’s corporate claim standards and client expectations.

Qualifications:

Experience: Extensive experience in handling pharmacy liability claims is required. Previous experience with bodily injury claims and litigation is highly desirable.
Skills: Strong proficiency in managing complex claims, excellent data entry skills, and a keen eye for detail.
Negotiation: Proven ability to evaluate and negotiate settlements effectively when liability is established.
Customer Service: Demonstrated expertise in providing outstanding customer service and managing client interactions.
Tech-Savvy: Experience with claims management systems and a solid understanding of relevant industry regulations and standards.

Why Join Us:

Career Growth: This position offers potential for advancement within CCMSI, with opportunities to move into senior-level roles.
Supportive Environment: Join a team of professionals dedicated to excellence in claim management and client service.
Flexibility: Depending on the location, options for hybrid or remote work arrangements may be available.

If you have a proven track record in pharmacy liability claims, including experience with BI and litigation, and are ready to advance your career, we encourage you to apply.

Responsibilities:
Investigate, evaluate and adjust multi-line 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 multi-line claims. Negotiate any disputed bills or invoices for resolution.
Authorize and make payments of multi-line 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 multi-line 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 multi-line 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.
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.
Initiative to set and achieve performance goals.
Good analytic and negotiation skills.
Ability to cope with job pressures in a constantly changing environment.
Knowledge of all lower level claim position responsibilities.
Must be detail oriented and a self-starter with strong organizational abilities.
Ability to coordinate and prioritize required.
Flexibility, accuracy, initiative and the ability to work with minimum supervision.
Discretion and confidentiality required.
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

10+ years multi-line claim experience is required.

Proven experience in handling pharmacy liability claims is required.

Computer Skills

Proficient with Microsoft Office programs.

Certificates, Licenses, Registrations

Adjusters license is preferred.

AIC, ARM or CPCU Designation 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.

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