Workers' Compensation Claim Adjuster I

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.

Location : Initial in-office training period, transitioning to a hybrid schedule

Hours : Monday through Friday, 8 : 00 AM to 4 : 30 PM

We are seeking a detail-oriented and highly organized individual to join our team as a Workers' Compensation Claim Representative I .

This role involves the investigation and adjustment of Nevada workers' compensation claims for a single dedicated account.

The ideal candidate will have 0-3 years of experience in workers' compensation claims adjustment.

The key responsibilities include conducting thorough investigations of assigned workers' compensation claims, adjusting claims in accordance with NV state regulations and company guidelines, and maintaining clear and accurate documentation of all claim activities.

The role also involves ensuring timely and effective communication with claimants, employers, and medical providers, managing multiple tasks efficiently, adjusting quickly to changing priorities, and seamlessly resuming tasks after interruptions to meet deadlines.

Required skills and experience for this position include entry-level to 3 years of experience in workers' compensation claims adjustment, strong organizational skills and attention to detail, the ability to multi-task and manage changing priorities, excellent written and verbal communication skills, proficiency in using claims management software and other relevant technology, the ability to work independently and as part of a team, and strong analytical and problem-solving abilities.

Additional preferred skills include familiarity with NV workers' compensation laws and regulations, experience in customer service or client-facing roles, and the ability to handle sensitive information with discretion and confidentiality.

This position offers an excellent opportunity for growth and development, with the potential for promotion to a Workers' Compensation Claim Representative II or a more senior-level position.

You will be accountable for the quality of claim services as perceived by our clients and in alignment with CCMSI's corporate claim standards.

If you are a motivated individual with a passion for providing excellent service and a keen eye for detail, we encourage you to apply for this exciting opportunity.

Responsibilities

• Investigate and adjust workers compensation claims in accordance with established claims handling procedures using CCMSI guidelines and direct supervision.
• Review medical, legal and miscellaneous invoices to determine if reasonable and related to the ongoing workers compensation claims.

Negotiate any disputed bills for resolution.

• Authorize and make payment of workers compensation claims utilizing a claim payment program in accordance with industry standards and within settlement authority.
• Negotiate settlements with claimants and attorneys in accordance with client's authorization.
• Assist in selection and supervision of defense attorneys.
• Assess and monitor subrogation claims for resolution.
• Prepare reports detailing claims, payments and reserves.
• Provide reports and monitor files, as required by excess insurers.
• Compliance with Service Commitments as established by team.
• Delivery of quality claim service to clients.
• 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.
• 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

0- 3 or more years of workers compensation claim experience or other related industry experience is required.

Medical Terminology knowledge is helpful.

Computer Skills

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

Certificates, Licenses, Registrations

none required.

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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