Overview
Workers' Compensation Claim Representative II
Take your career to the next level at CCMSI, a nationally recognized, employee-owned leader in third-party administration for self-insurance services. We’re looking for a dedicated Workers' Compensation Claim Representative II to join our Maitland, FL office, with the flexibility of a hybrid schedule and standard hours from Monday through Friday, 8:00 am to 4:30 pm. This role not only provides room for growth but also offers the chance to contribute to a company certified as a Great Place To Work, with employee satisfaction and retention rates in the 95th percentile.
Why CCMSI?
- Culture: Our core values—integrity, passion, and enthusiasm—define how we treat each other as valued partners.
- Career Development: We provide structured development, including internships, training, and career advancement opportunities.
- Outstanding Benefits: Enjoy 4 weeks of paid time off in your first year, 10 paid holidays, comprehensive health coverage, and retirement options with 401K and ESOP.
- Work Environment: With manageable caseloads and resources to help you thrive, we create a place where employees look forward to coming to work every day.
Role Overview:
As a Workers' Compensation Claim Representative II, you’ll investigate and adjust workers' compensation claims while providing exceptional service to CCMSI clients and meeting our corporate standards. This role also offers advanced training, potentially setting you up for future promotion to a senior claims position.
Key Responsibilities:
- Conduct thorough investigations and adjustments for workers' compensation claims, ensuring high standards of service.
- Engage in audits and compliance activities and respond proactively to customer feedback.
- Deliver quality service to our clients, meeting or exceeding performance standards in accuracy and timeliness.
Skills & Competencies:
- Teamwork: Collaborate effectively, work well within a team, and remain adaptable in a changing environment.
- Open to Coaching: Embrace feedback and demonstrate a willingness to improve and grow.
- Communication: Strong verbal and written skills to communicate clearly internally and externally.
- Self-Starter: High level of initiative, organization, and ability to manage priorities independently.
- Confidentiality: Exercise discretion and handle information responsibly.
Performance Measurement:
- Quality of Service: Measured through audits, compliance metrics, and customer feedback.
- Attendance & Reliability: Predictable attendance within service hours is essential for client satisfaction.
- Responsiveness: Timely, clear communication and proactive client support.
Qualifications:
A Level II Claim Representative typically brings 5-10 years of claims management experience or equivalent education, along with a proven track record in claims handling. A Florida adjuster’s license is required, and a Georgia, South Carolina, North Carolina Virgina and West Virginia licenses are also highly desirable.
If you’re ready to make a meaningful impact in a collaborative environment with opportunities for career growth, apply today to join our team at CCMSI!
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
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
Florida adjusters license is required.
GA, SC, NC and VA/WV licenses are a plus
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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