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Compensation Claims Specialist
2 months ago
At CCMSI, we are committed to attracting top-tier talent to our team of experts. As a premier Third Party Administrator in self-insurance solutions, we are driven by a shared mission of providing outstanding service to our clients. Being an Employee-Owned Company, we prioritize the growth of our personnel through structured career advancement programs, recognizing and rewarding both individual and team achievements. Our status as a certified Great Place To Work reflects our employee satisfaction and retention rates, which are in the 95th percentile.
Why consider a career with CCMSI?
- Culture: Our Core Values are deeply ingrained in our culture, guiding how we treat our employees as valued partners—with integrity, passion, and enthusiasm.
- Career Development: CCMSI provides extensive internships and internal training initiatives for career progression within our organization.
- Benefits: Our benefits package includes 4 weeks of paid time off in your first year, in addition to 10 paid holidays, along with Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP.
- Work Environment: We strive to create a workplace where employees look forward to coming in each day, equipped with the necessary resources to excel in their roles, while ensuring manageable caseloads for our claims staff.
We are in search of a Compensation Claims Specialist for our office. This hybrid role allows for a combination of in-office and remote work following an initial training phase. The position involves managing workers' compensation claims and requires 3-5 years of experience in claims adjusting.
As a Compensation Claims Specialist, your responsibilities will include investigating and adjusting assigned claims, ensuring that the quality of claim services aligns with the standards set by CCMSI and our clients. This role also serves as an advanced training opportunity with the potential for upward mobility within the claims department.
Responsibilities- Conduct thorough investigations, evaluations, and adjustments of claims in compliance with established standards and regulations.
- Set reserves and/or provide reserve recommendations within defined authority levels.
- Review and approve medical, legal, and miscellaneous invoices to assess their reasonableness and relevance to the claims.
- Authorize and process claim payments according to established procedures and industry standards.
- Negotiate settlements in accordance with Corporate Claim Standards and state regulations.
- Assist in the selection and oversight of external vendors related to claims.
- Monitor and manage subrogation claims for resolution.
- Maintain a personal diary on the claims system.
- Ensure client satisfaction throughout the claims process.
- Prepare reports detailing claim status, payments, and reserves as needed.
- Calculate disability rates in accordance with state laws.
- Facilitate effective communication with clients, claimants, and relevant parties during the claims adjustment process.
- Conduct training sessions or claim reviews for designated clients as required.
- Participate in hearings, mediations, and informal legal conferences as appropriate.
- Adhere to Corporate Claim Handling Standards and specific client instructions.
- Perform additional duties as assigned.
Education and Experience
3-5 years of experience in adjusting lost time claims.
Computer Skills
Proficient in Microsoft Office applications such as Word, Excel, and Outlook.
Certificates, Licenses, Registrations
No specific certifications required.
CORE VALUES & PRINCIPLES
Responsible for upholding the CCMSI Core Values & Principles, which include performing with integrity, focusing passionately on client service, embracing a client-centered vision, and maintaining a constructive and enthusiastic atmosphere.
CCMSI is an Affirmative Action/Equal Employment Opportunity employer offering a comprehensive benefits package, including Medical, Dental, Vision, Prescription Drug, Flexible Spending, Life, ESOP, and 401K.
