Overview
Workers' Compensation Claim Consultant - Hybrid Role
Location: Reporting to Dallas, TX branchWork Arrangement: Hybrid after the initial training period (2 days in-office per week)
About CCMSI:At CCMSI, we bring together the best and brightest in third-party administration, offering self-insurance services with a commitment to exceptional client service. As an employee-owned company and a Certified Great Place to Work, we support structured career development, recognize achievements, and maintain high employee satisfaction and retention rates.
Position Overview:The Workers' Compensation Claim Consultant will investigate and adjust workers' compensation claims for multiple accounts, ensuring quality service aligned with our corporate standards. This role is ideal for experienced professionals and can serve as a stepping stone toward a senior-level position.
Key Requirements:
- Experience: 5+ years of Texas workers' compensation claims handling experience preferred
- License: TX Adjuster’s License required
- Skills: Microsoft Office proficiency, strong customer service, time management, and organizational skills
Why Join CCMSI?
- Culture: We value integrity, passion, and enthusiasm, treating each team member as a partner in our mission.
- Career Development: Enjoy access to internships, training programs, and advancement opportunities.
- Comprehensive Benefits: 4 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: We offer a supportive, resource-rich work environment with manageable caseloads for claims staff.
Consider CCMSI for a career where you’re valued, supported, and set up for success!
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.)
- Assess and monitor subrogation claims for resolution.
- Review and maintain personal diary on claim system.
- Client satisfaction.
- Prepare reports detailing claim status, payments and reserves, as requested.
- Compute disability rates in accordance with state laws.
- Effective and timely coordination of communication with clients, claimants and appropriate parties throughout the claim adjustment process.
- Prepare newsletter articles, as requested.
- Provide notices of qualifying claims to excess/reinsurance carriers.
- Handle more complex and involved claims than lower level claim positions with minimum supervision.
- Conduct claim reviews and/or training sessions for designated clients, as requested.
- Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.
- Compliance with Corporate Claim Handling Standards and special client handling instructions as established.
- Performs other duties as assigned.
Qualifications
Education and/or Experience
Five or more years claims experience is required.
Computer Skills
Proficient using MicroSoft Office products such as Word, Excel, Outlook, etc.
Certificates, Licenses, Registrations
Texas Adjsusters license is 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 included Medical, Dental, Vision, Prescription Drug, Flexible Spending, Life, ESOP and 401K.
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