Overview
Workers' Compensation Claim Representative II
Flexible Start Times | Hybrid Schedule | Career Growth Opportunity
At CCMSI, we seek the best and brightest talent to join our team. As a leading Third Party Administrator in self-insurance services, we are driven by a shared purpose: to deliver exceptional service to our clients. We’re an Employee-Owned Company, focused on developing our staff through structured career development, recognizing individual and team efforts, and maintaining our certified Great Place To Work status with a satisfaction and retention ranking in the 95th percentile.
Why Join CCMSI?
- Culture: We value integrity, passion, and enthusiasm, treating our employees as partners.
- Career Development: Robust training programs and internships provide pathways for growth and advancement.
- Benefits: Generous benefits include four weeks of paid time off in your first year, 10 paid holidays, Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP.
- Work Environment: Supportive environment with manageable caseloads and resources to succeed.
Position Highlights
Job Title: Workers' Compensation Claim Representative IISchedule: Flexible start times between 6:00 am and 8:30 am, with a hybrid schedule available after the initial training period.Location: Las Vegas, NV - Hybrid (after training)Requirements: Nevada adjuster’s license required
Key Responsibilities
- Investigate and adjust assigned workers' compensation claims, primarily indemnity claims.
- Ensure service quality aligns with CCMSI’s standards and client expectations.
- Manage claims to meet best practices, client needs, and statutory deadlines.
Preferred Experience
- 3+ years of Nevada indemnity claim handling experience is highly desirable.
Training & SupportTraining is tailored to individual needs, with support from experienced trainers and resources to ensure familiarity with our systems and claim procedures.
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
Nevada adjuster’s license required
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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