Workers' Compensation Claims Adjuster (Hybrid)

Job Summary

The Workers' Compensation Claim Consultant is responsible for the investigation, evaluation, administration, and resolution of workers' compensation claims across multiple client accounts and industries. This role manages claims from assignment through closure while ensuring compliance with client handling instructions, applicable state laws, and CCMSI's claim handling standards.

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 within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate.
• Absorb 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 Workers’ Compensation claims experience.
• Active MS and/or AL adjusters license.
• Proficiency with Microsoft Office products, including Word, Excel, and Outlook.
• Preferred: Prior TPA experience, bilingual proficiency (Spanish).