Overview
Workers' Compensation Claim Representative II (Hybrid) – Reading, MA
At CCMSI, we seek the best and brightest to join our team of skilled professionals. As a leading Third Party Administrator in self-insurance services, we are driven by a shared commitment to delivering exceptional client service. As an Employee-Owned Company, we invest in our employees' career growth, offering structured career development, rewards for individual and team accomplishments, and a work environment that promotes satisfaction, reflected by our ranking in the 95th percentile in employee satisfaction and retention. Certified as a Great Place to Work, CCMSI fosters a culture of integrity, passion, and enthusiasm, treating employees as valued partners.
Reasons to consider a career with CCMSI:
- Culture: Our Core Values emphasize integrity, passion, and enthusiasm, creating a supportive work culture.
- Career Development: CCMSI offers comprehensive training and career advancement programs.
- Benefits: Enjoy four weeks of paid time off in your first year, 10 paid holidays, and robust benefits, including Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP.
- Work Environment: We prioritize manageable caseloads and provide the resources you need to succeed, fostering a workplace where employees enjoy coming to work.
Position Summary:
The Workers' Compensation Claim Representative II is responsible for investigating and adjusting assigned workers’ compensation claims, with accountability for the quality of service delivered to CCMSI clients and compliance with corporate claim standards. This hybrid position, based out of our Reading, MA office, operates Monday through Friday, 8:00 am to 4:30 pm, covering MA, CT, and RI jurisdictions.
Requirements:
- License: Massachusetts Adjuster’s License is required.
- Experience: 5-7 years in claims, ideally with a strong technical background.
- Skills: Effective communication skills and a commitment to extra effort when required.
This role also offers a valuable training pathway for advancement to more senior claim positions. Join CCMSI and be part of a dynamic, supportive team committed to your success!
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
Level II Claim Rep will possess excellent claims management skills, typically with 5 to 10 years of experience or equivalent education, along with proven claims handling performance levels.
Computer Skills
Proficient with Microsoft Office programs.
Certificates, Licenses, Registrations
Massachusetts Adjuster’s License is required.
CT and/or RI adjusters license is highly desired.
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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