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 Representative I
Join our dynamic team as a Workers' Compensation Claim Representative I, where you’ll have the opportunity to grow your career in a supportive, hybrid environment. After an initial training period, this role offers the flexibility of a hybrid schedule while working on a single dedicated client account.
In this position, you’ll be responsible for investigating and adjusting assigned workers' compensation claims, with a focus on quality and thoroughness. Your performance will be measured by audits for quality, claim reviews, and your ability to meet client and corporate claim standards. Previous experience handling medical-only workers' compensation claims and knowledge of medical terminology are highly desirable but not required.
Key Responsibilities:
- Investigate and adjust workers' compensation claims
- Ensure high-quality service and compliance with CCMSI's claim standards
- Manage and prioritize tasks effectively with minimal supervision
- Collaborate with team members to meet deadlines and client expectations
Must-Haves:
- Excellent oral and written communication skills
- Strong organizational skills and attention to detail
- Self-starter with the ability to work independently and take initiative
- Flexibility and adaptability in a fast-paced environment
This role can serve as an advanced training position with future promotion opportunities to Workers' Compensation Claim Representative II or more senior positions. If you’re looking for a position where you can grow and make an impact, we’d love to hear from you!
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
3 or more years of workers compensation claim experience or other related industry experience is required.
Computer Skills
Proficient using Microsoft Office programs such as: Word, Excel, Outlook, etc.
Certificates, Licenses, Registrations
- Adjuster's license is preferred but not required.
- Candidates with a California Self-Insurance Administrator (SIP) certification will be given strong consideration and are highly 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 including Medical, Dental, Prescription Drug, Vision, Flexible Spending, Life, ESOP and 401K.
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