Workers' Compensation Claims Consultant

7 days ago


Salem, Oregon, United States CCMSI Full time
Overview

At CCMSI, we strive to deliver exceptional service to our clients by fostering a culture of excellence, integrity, and passion. As a leading Third Party Administrator in self-insurance services, we are committed to developing our staff through structured career development programs, recognizing individual and team efforts, and maintaining a Great Place To Work certification.

Key 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 with 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 of Utah workers' compensation claims experience is required.
  • Computer Skills: Proficient using MicroSoft Office products such as Word, Excel, Outlook, etc.
  • Certificates, Licenses, Registrations: WA Adjusters license is preferred.

CCMSI is an Affirmative Action/Equal Employment Opportunity employer offering an excellent benefit package, including Medical, Dental, Vision, Prescription Drug, Flexible Spending, Life, ESOP, and 401K. We are committed to upholding our Core Values & Principles, which include performing with integrity, passionately focusing on client service, embracing a client-centered vision, and maintaining contagious enthusiasm for our clients.



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