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Workers' Compensation Claim Associate I Levelup

4 months ago

Danville, United States CCMSI Full time

Overview:
**Are you looking to launch a rewarding career in insurance claims?** Join our LevelUP Career Pathways Program at CCMSI as a Workers' Compensation Claim Associate I (LevelUP). This role is designed for individuals eager to progress through our structured training program towards becoming a skilled Claim Representative.

**Why Choose Claims Adjusting?**
- ** Make a Positive Difference**: help individuals and families overcome setbacks by supporting their recovery and rehabilitations through your work.
- ** Career Growth Opportunities**: from entry-level positions to leadership positions, there are endless possibilities.
- ** Flexible schedules** in a hybrid work environment
- ** Excellent pay and benefits**

**What Do Claims Adjusters Do?**
- ** Problem Solve Each Day**: help people return to work after accidents and recover from natural disasters
- ** Investigate**: interview witnesses, assess damages and negotiate settlements
- ** Communicate**: Interact with clients, injured workers and attorneys in a team environment

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.

**Responsibilities**:
As a **Claim Associate I LevelUP**, you'll handle the initial phases of claims investigation and evaluation. Under close supervision, you'll focus on non-litigated indemnity cases and contested medical-only claims. Your responsibilities include setting up claim files, coordinating medical treatments, and managing communications with clients and claimants.
- Investigate, evaluate and adjust medical only claims, contested medical-only claims and handle a maximum of 30 indemnity claims under direct supervision.
- Establish reserves and/or provide reserve recommendations within established authority levels under direct supervision.
- Set up designated claim files and complete all set up instructions, as requested.
- Set up independent medical exams as deemed necessary under direct supervision.
- Request and monitor medical treatment of designated claims in accordance with corporate claim standards.
- Review and approve related medical, legal, damage estimates and miscellaneous invoices on designated claims. Negotiate any disputed bills/invoices for resolution under direct supervision.
- As appropriate, make referrals to outside vendors on designated cases under direct supervision. (i.e., legal surveillance, case management, etc.)
- Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the claim adjustment process.
- Authorize and make payments on claims utilizing a claim payment program in accordance with industry standards and within established authority levels under direct supervision.
- Compute disability rates in accordance with state laws under direct supervision, when appropriate.
- Summarize all correspondence and medical records in claim log notes as well as file same in the appropriate claim.
- Review and maintain personal diary on claim system.
- Provide technical and clerical claims support to designated clients, as requested.
- Compliance with corporate claim standards and special client handling instructions as established.
- Will act as a back-up to designated adjusters when needed.
- Performs other duties as assigned.

Qualifications:

- An interest in building a career in insurance claims.
- Excellent oral and written communication skills.
- Excellent organization and time management abilities.
- Individual must be a self-starter.
- Critical thinking skills and the ability to work independently.
- Ability to coordinate and prioritize required with exceptional time management.
- Ability to operate general office equipment and perform clerical duties.
- Flexibility, initiative, and the ability to