Workers' Compensation Claim Specialist, Senior

3 weeks ago

Concord, 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.

We are seeking a remote Workers' Compensation Claim Specialist, Senior to join our team, reporting to our Concord, CA office. This position manages claims across multiple client accounts within construction, staffing, and commercial trucking industries. A California Self-Insurance Plan (SIP) license is required, and occasional travel may be necessary for in-person claim reviews.

As a Workers' Compensation Claim Specialist, Senior, you will be responsible for investigating and adjusting assigned claims. This role also serves as an advanced training opportunity, preparing individuals for potential promotion to supervisory or management positions. You will be accountable for delivering high-quality claim services that meet the expectations of CCMSI clients and align with our 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.
  • 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.
  • Handle more complex and involved claims than intermediate/lower level claims positions with minimum supervision, as requested.
  • Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.
  • Supervision of all claim activity for specified accounts.
  • 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

15+ years claim experience is required.

Computer Skills

Proficient using Microsoft Office programs such as Word, Excel, Outlook, etc.

Certificates, Licenses, Registrations

California SIP is required.

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

#CCMSICareers #ESOP #EmployeeOwned #GreatPlaceToWorkCertified #CAWorkComp #WorkersCompensation #ClaimSpecialist #RemoteWork #ConcordCA #InsuranceJobs

#SIPLicense #ConstructionIndustry #Staffing #Trucking #CareerDevelopment #ClaimsInvestigation #WorkCompClaims #IND123

  • Workers' Compensation Claim Specialist

    1 month ago

    Concord, 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...

  • Workers' Compensation Claims Examiner

    2 weeks ago

    Concord, United States Sedgwick Full time

    Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for...

  • Workers Compensation Claims Associate | Concord, CA

    1 week ago

    Concord, United States Sedgwick Claims Management Services Full time

    To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices. ESSENTIAL FUNCTIONS and RESPONSIBILITIES - Adjusts medical-only Workers Compensation, Claims, Associate, Compensation, Worker, Administrative, Insurance, Medical

  • Remote Senior Workers' Compensation Adjuster

    15 hours ago

    Concord, 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,...

  • Workers Compensation Claims Associate | Concord, CA

    2 weeks ago

    Concord, United States Sedgwick Full time

    Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your...

  • Workers' Compensation Claim Supervisor

    3 weeks ago

    Concord, 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,...

  • Workers Compensation Claims Examiner

    1 week ago

    Concord, United States Sedgwick Claims Management Services Full time

    To analyze California Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. Workers Compensation, Claims, Examiner, Compensation, Worker, Administrative, Insurance

  • Claim Representative

    2 weeks ago

    Concord, United States Sedgwick Full time

    Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for...

  • Senior Compensation Analyst

    3 weeks ago

    Concord, United States Concord Hospital Health System Full time

    Reporting to the Director of Total Rewards and HR Operations, the Senior Compensation Analyst participates in the development and administration of the compensation program including job description development, job analysis, job evaluation, salary surveys, market analysis, equity analysis and ad-hoc reporting. Maintains compensation structure and job...

  • Senior Compensation Analyst

    1 month ago

    Concord, United States Concord Hospital Health System Full time

    Reporting to the Director of Total Rewards and HR Operations, the Senior Compensation Analyst participates in the development and administration of the compensation program including job description development, job analysis, job evaluation, salary surveys, market analysis, equity analysis and ad-hoc reporting. Maintains compensation structure and job...

  • Senior Compensation Analyst

    1 month ago

    Concord, United States Concord Hospital Health System Full time

    Reporting to the Director of Total Rewards and HR Operations, the Senior Compensation Analyst participates in the development and administration of the compensation program including job description development, job analysis, job evaluation, salary surveys, market analysis, equity analysis and ad-hoc reporting. Maintains compensation structure and job...

  • Senior Compensation Analyst

    1 month ago

    Concord, United States Concord Hospital Health System Full time

    Reporting to the Director of Total Rewards and HR Operations, the Senior Compensation Analyst participates in the development and administration of the compensation program including job description development, job analysis, job evaluation, salary surveys, market analysis, equity analysis and ad-hoc reporting. Maintains compensation structure and job...

  • Accounts Receivable Specialist

    1 week ago

    Concord, United States ClearChoiceMD Full time

    ClearChoiceMD Urgent Care, an Emergence Health Holdings organization, is building a team of professionals dedicated to meeting all the needs of the community, from infant to elders, school to industry and everywhere in between. ClearChoiceMD is a patient focused organization with a strong emphasis on teamwork. Founded by physicians who know and understand...

  • Caregiver/Personal Care Specialist

    7 days ago

    Concord, United States Senior Helpers - Concord Full time

    Job DescriptionJob Description Urgently Hiring! It's more than just a job!  We are looking for YOU to make a difference in someone's life!  Senior Helpers is the first national in-home care company to be recognized as a Great Place to Work as a leading senior care provider!   Senior Helpers was founded in 2002 with a vision to help seniors age...

  • Accounts Receivable Specialist

    7 days ago

    Concord, United States ClearChoiceMD Full time

    Job DescriptionJob DescriptionClearChoiceMD Urgent Care, an Emergence Health Holdings organization, is building a team of professionals dedicated to meeting all the needs of the community, from infant to elders, school to industry and everywhere in between. ClearChoiceMD is a patient focused organization with a strong emphasis on teamwork. Founded by...

  • Accounts Receivable Specialist

    1 day ago

    Concord, United States ClearChoiceMD Full time

    Job DescriptionJob DescriptionClearChoiceMD Urgent Care, an Emergence Health Holdings organization, is building a team of professionals dedicated to meeting all the needs of the community, from infant to elders, school to industry and everywhere in between. ClearChoiceMD is a patient focused organization with a strong emphasis on teamwork. Founded by...

  • Claims Adjuster Trainee

    1 week ago

    Concord, United States Progressive Insurance Full time

    As a claims adjuster trainee, you'll learn how to help customers get back on the road after an accident. This is not a field position which means you'll be building relationships with customers over the phone. In a fast-paced environment, you'll learn how to resolve a heavy case load of claims efficiently while managing the claims process from start to...

  • EHS Specialist

    4 weeks ago

    Concord, United States HP Hood LLC Full time

    **Job Summary**: Broad-spectrum Environmental Health & Safety (EHS) Professional position that provides technical and professional support services to operations staff, with guidance and direction from either the Senior EHS Manager or Plant Manager and Director, EHS (dependent upon site). This is an on-the-floor (high visibility/floor presence)...

  • EHS Specialist

    4 weeks ago

    Concord, United States H P Hood LLC Full time

    Job Summary: Broad-spectrum Environmental Health & Safety (EHS) Professional position that provides technical and professional support services to operations staff, with guidance and direction from either the Senior EHS Manager or Plant Manager and Director, EHS (dependent upon site). This is an on-the-floor (high visibility/floor presence)...

  • Accounts Receivable Specialist

    1 week ago

    Concord, United States ClearChoiceMD Full time

    ClearChoiceMD Urgent Care, an Emergence Health Holdings organization, is building a team of professionals dedicated to meeting all the needs of the community, from infant to elders, school to industry and everywhere in between. ClearChoiceMD is a patient focused organization with a strong emphasis on teamwork. Founded by physicians who know and understand...