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Hybrid Workers' Compensation Claim Adjuster

2 months ago

Reading, 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.

Workers' Compensation Claim Consultant

Location: Reading, MA (Hybrid Schedule)

Overview: Join CCMSI as a Workers' Compensation Claim Consultant and be part of a dynamic team that handles claims from start to finish, including both litigated and non-litigated files. After initial training, you'll enjoy a hybrid schedule, working 2 days in the office one week and 3 days in the office the next.

Key Responsibilities:

  • Investigate and adjust assigned workers' compensation claims within MA, CT, and RI jurisdictions.
  • Manage the entire claims process, ensuring all actions meet our corporate claim standards.
  • Participate in claim reviews and contribute to the overall success of our claims handling process.

Qualifications:

  • Previous experience in workers' compensation claim adjusting, with expertise in MA, CT, and RI claims.
  • CT and RI adjuster licenses are required.
  • Strong decision-making abilities, attention to detail, and excellent organizational skills.
  • Exceptional customer service skills, with a focus on client satisfaction.

This role offers the opportunity for advanced training and potential promotion to a more senior-level claim position. If you're a motivated professional looking to grow within a supportive environment, apply today and become a key player in delivering top-quality claim services at CCMSI.

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 in MA, CT, and/or RI jurisdictions.

Computer Skills

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

Certificates, Licenses, Registrations

CT and RI adjuster licenses are 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.

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