Workers' Compensation Claim Consultant

About the role

CCMSI partners with global clients to solve complex risk management challenges, delivering measurable results through advanced technology, collaborative problem‑solving, and a commitment to client success. As the largest privately owned Third Party Administrator (TPA), CCMSI provides customized claim solutions that protect employees, assets, and reputations, and is a certified Great Place to Work® where employee‑owners are empowered to grow and collaborate. We are seeking an experienced Nevada Workers’ Compensation Claim Consultant to manage a complex portfolio of claims with confidence, empathy, and sound professional judgment. With 5+ years of hands‑on claims experience, you will lead investigations, guide claim strategy, and ensure fair, timely resolutions, while also having a clear development pathway to senior claim positions. Success in this role is measured by quality claim handling, compliance and audit performance, timeliness and accuracy, strong client partnership, professional judgment, and cultural alignment—reflecting CCMSI’s core values of doing what’s right, leading with transparency, performing with integrity, chasing excellence, owning outcomes, and winning together.

Responsibilities

• Investigate, evaluate, and adjust claims in accordance with claim handling standards and applicable laws.
• Establish reserves and provide reserve recommendations within assigned authority levels.
• Review and approve medical, legal, damage estimate, and miscellaneous invoices; negotiate disputed charges when necessary.
• Authorize and issue claim payments in accordance with established procedures, industry standards, and payment authority.
• Negotiate claim settlements in compliance with Corporate Claim Standards, client-specific instructions, and state laws.
• Select, refer, and oversee claim files assigned to outside vendors, including legal counsel, surveillance, and case management services.
• Evaluate and monitor subrogation opportunities through resolution.
• Maintain timely and accurate claim diaries and documentation.
• Promote and maintain a high level of client satisfaction.
• Prepare claim status, payment, and reserve reports as requested.
• Calculate disability rates in accordance with state regulations.
• Ensure timely and effective communication with clients, claimants, and other involved parties throughout the claims process.