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Hybrid Liability Claim Associate I

3 months ago

Danville, 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 dedicated and detail-oriented individual to join our team in handling minor liability claims for a dedicated client account. This position requires commuting to the Danville, IL office. The role is an hourly hybrid position, after initial training period, with the schedule being Monday to Friday, 8:00 AM to 4:30 PM. Training and testing for a Texas adjuster license are mandatory.

The ideal candidate will possess excellent customer service skills, the ability to handle conflict and respond professionally, and strong oral and written communication skills, including letter writing. Responsibilities include assisting Indemnity and/or P&C Adjusters with technical and clerical support of designated claims under close supervision. This position may serve as a training role for promotion to the Claims Level Up program and is accountable for the quality of claim service as perceived by CCMSI clients and within Corporate Claim Standards.

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Responsibilities

Set up designated claim files and complete all set up instructions, as requested. Learn multi line coverages, check claim for correct coverage type, assign out files to adjusters when supervisor is out, if applicable. Set up independent medical exams as deemed necessary under direct supervision. Request and monitor medical treatment of designated claims in accordance with corporate claim standards. Review and approve related medical, legal, damage estimates and miscellaneous invoices on designated claims. Assist adjuster with recorded statements. Negotiate any disputed bills/invoices for resolution under direct supervision. As appropriate, make referrals to outside vendors on designated cases under direct supervision. (. legal, surveillance, case management, Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the claim adjustment process. Authorize and make payments on claims utilizing a claim payment program in accordance with industry standards and within established authority levels under direct supervision. Summarize all correspondence and medical records in claim log notes as well as file same in the appropriate claim. Compute disability rates in accordance with state laws under direct supervision, when appropriate. Handle management of Navex and member/client complaints, if applicable. Assist in running and updating reports as needed. Return provider calls. Review and maintain personal diary on claim system. Provide technical and clerical claims support to designated clients and claim staff, as requested. Working document and bill queues. Process voids, refunds and recoveries. Act as backup for adjuster or supervisor when out of the office. Client Satisfaction. Compliance with corporate claim standards and special client handling instructions as established. Handle claim overflow as needed. 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. Individual must be a self-starter with strong organizational abilities. Ability to coordinate and prioritize required. Ability to operate general office equipment and perform clerical duties. Flexibility, initiative, and the ability to work with a minimum of direct supervision a must. Discretion and confidentiality required. Ability to work as a team member in a rapidly changing environment. 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

Associate’s degree or two year’s related business experience.

Knowledge of medical terminology preferred.

Computer Skills

Proficient with Microsoft Office programs.

Certificates, Licenses, Registrations

Must pass Texas Adjuster license as requested.

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.

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