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Remote Workers' Comp Claim Adjuster

2 months ago

Irvine, 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 Consultant is responsible for the investigation and adjustment of assigned claims. This is a remote position for an experienced California Workers' Compensation Adjuster. Previous experience adjusting California Workers' Compensation claims is required, and California Self-Insurance Plans (SIP) certification is preferred. The consultant will manage a single client with multiple accounts, ensuring the quality of claim services as perceived by CCMSI clients and adhering to our corporate claim standards. Additional responsibilities include thorough documentation, effective communication with all parties involved, compliance with state regulations, and the ability to handle complex claims. This role may serve as an advanced training position, with the potential for promotion to a more senior-level claim position.

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 California Claims Adjusting experience is required.

Computer Skills

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

Certificates, Licenses, Registrations

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

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