Workers' Compensation Claim Adjuster

1 week ago

Scottsdale, United States CCMSI Full time

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.

The **Workers' Compensation Claim Adjuster** is tasked with investigating and managing assigned claims remotely across multiple accounts. This position offers a manageable caseload and serves as an advanced training opportunity for potential promotion to a senior claim position. The role requires a minimum of 5 years of experience adjusting California Workers' Compensation claims or CA SIP certification. The adjuster is accountable for delivering high-quality claim services aligned with CCMSI client expectations and corporate claim standards.

**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.)
- Assess and monitor subrogation claims for resolution.
- Review and maintain personal diary on claim system.
- Client satisfaction.
- Prepare reports detailing claim status, payments and reserves, as requested.
- Compute disability rates in accordance with state laws.
- Effective and timely coordination of communication with clients, claimants and appropriate parties throughout the claim adjustment process.
- Prepare newsletter articles, as requested.
- Provide notices of qualifying claims to excess/reinsurance carriers.
- Handle more complex and involved claims than lower level claim positions with minimum supervision.
- Conduct claim reviews and/or training sessions for designated clients, as requested.
- Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.
- Compliance with Corporate Claim Handling Standards and special client handling instructions as established.
- Performs other duties as assigned.

Qualifications:
**Education and/or Experience**

Five or more years claims experience is required.

**Computer Skills**

Proficient using MicroSoft Office products such as Word, Excel, Outlook, etc.

**Certificates, Licenses, Registrations**

California SIP or a minimum of 5 years of California WC Claims adjusting experience is required

**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 included Medical, Dental, Vision, Prescription Drug, Flexible Spending, Life, ESOP and 401K.

CCMSICareers #WorkersCompensati

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