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Workers' Compensation 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 Specialist is responsible for the investigation and adjustment of assigned claims. This position may be used as an advanced training position for promotion consideration for supervisory/management positions. The Claim Representative is accountable for the quality of claim services as perceived by CCMSI clients and within our corporate claim standards.

This is a remote position handling California Workers' Compensation Claims. A California Self-Insurance Administrator (SIP) certification and 3-5 years of experience adjusting California Workers' Compensation Claims are required. The role involves working on a dedicated client account.

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.)
  • 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 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.
  • 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.
  • 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

3+ years California Workers' Compenasation claims experience is required.

Computer Skills

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

Certificates, Licenses, Registrations

California SIP is required

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

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