Workers' Compensation Claims Adjuster
3 weeks ago
At CCMSI, we are united by a common purpose of delivering exceptional service to our clients. As a leading Third Party Administrator in self-insurance services, we are committed to developing our staff through structured career development programs, rewarding and recognizing individual and team efforts.
Culture:
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.
Career Development:
CCMSI offers robust internships and internal training programs for advancement within our organization. This position offers a hybrid work arrangement, providing flexibility while allowing you to maintain the quality of service expected by our clients.
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. 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.
Qualifications:
Five or more years AZ workers' compensation claims experience is required. Proficient using MicroSoft Office products such as Word, Excel, Outlook, etc. CO/UT Adjusters license is preferred. 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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