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.
Workers' Compensation Claim Adjuster (OR/WA) – Hybrid or Remote
CCMSI is seeking an experienced Workers' Compensation Claim Adjuster based in Salem, OR, or surrounding areas to join our team. This position can be hybrid or fully remote depending on your location and work preference. Occasional travel may be required for meetings, trainings, or claim reviews, though it is rare. The role offers a standard work schedule of Monday through Friday, 8:00 AM to 4:30 PM.
Key Responsibilities:
- Investigate, evaluate, and adjust complex workers' compensation claims in Oregon and Washington.
- Maintain detailed claim files, ensuring compliance with regulatory and company standards.
- Communicate effectively with injured workers, employers, medical professionals, and attorneys.
- Evaluate medical and legal reports to determine claim compensability and manage return-to-work strategies.
- Provide exceptional customer service to clients, demonstrating technical expertise and professionalism.
- Attend mediations, hearings, and other legal proceedings as necessary.
- Act as a resource for complex claim matters and assist in developing strategies for claim resolution.
- Participate in ongoing training and development to stay current with industry trends and regulations.
Qualifications:
- OR Adjuster's License required.
- 10+ years of experience in workers' compensation claim adjusting, with a strong focus on Oregon claims.
- Experience with Washington claims is highly desirable.
- Advanced technical skills in Oregon workers' compensation claims, including knowledge of state regulations, compensability, medical treatment guidelines, and settlements.
- AIC, ARM, or CPCU designation preferred but not required.
- Strong decision-making abilities and the capacity to handle a high volume of claims independently.
- Proven ability to manage large caseloads while maintaining accuracy and attention to detail.
- Excellent verbal and written communication skills.
- Proficiency in claim management systems and MS Office Suite.
This position offers potential for career advancement, including consideration for supervisory or management roles. If you're an experienced adjuster with the expertise to manage Oregon and Washington workers' compensation claims and a passion for delivering quality service, we'd love to hear from you!
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.
- Assist in the selection, referral and supervision of designated claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.)
- Review and maintain personal diary on claim system.
- Assess and monitor subrogation claims for resolution.
- Compute disability rates in accordance with state laws.
- Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the claim adjustment process.
- Provide notices of qualifying claims to excess/reinsurance carriers.
- Compliance with Corporate Claim Handling Standards and special client handling instructions as established.
- 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.
- Knowledge of Oregon Workers' Compensation Laws and Regulations: Adjusters must be familiar with Oregon's administrative rules, timelines, and guidelines for claim handling, including the Oregon Workers' Compensation Division requirements.
- Understanding of Compensability and Disability Guidelines: Proficiency in determining compensability under Oregon laws, including knowledge of what qualifies as a compensable injury and how temporary and permanent disability benefits are calculated.
- Experience with Vocational Rehabilitation Programs: Adjusters should understand Oregon's vocational rehabilitation system, return-to-work programs, and processes for managing injured workers' transition back to employment.
- Medical Treatment Guidelines: Familiarity with Oregon's medical treatment guidelines, including how to assess medical reports, manage medical provider relationships, and evaluate permanent disability ratings based on Oregon standards.
- Litigation Management: Experience handling workers' compensation disputes, attending hearings or mediations, and working with attorneys on contested cases under Oregon law.
- Strong Communication and Negotiation Skills: The ability to effectively communicate with claimants, employers, medical providers, and attorneys, as well as skills in negotiating settlements or resolving disputes in compliance with Oregon regulations.
- Experience with Time-Loss Claims: Proficiency in managing time-loss benefits, calculating wage loss, and ensuring accurate payments according to Oregon’s specific rules for injured workers.
- Case Law Knowledge: Understanding key Oregon workers' compensation case law, including how judicial decisions affect claim handling and compensability.
- Customer Service Orientation: Strong interpersonal skills and the ability to provide exceptional service to employers, injured workers, and stakeholders while adhering to the regulatory framework of Oregon claims.
Education and/or Experience
Ten years claims experience is required.
Computer Skills
Proficient using Microsof Office products such as Word, Excel, Outlook, etc.
Certificates, Licenses, Registrations
OR Adjuster's License required.
AIC, ARM OR CPCU Designation preferred.
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 included Medical, Dental, Vision, Prescription Drug, Flexible Spending, Life, ESOP and 401K.
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