Workers' Compensation Claim Adjuster (Fully Remote, CA Jurisdiction)

Overview:

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.

Job Summary: Workers' Compensation Claim Consultant, Senior (Fully Remote)

This role involves handling claims from onset to closure, ensuring timely documentation, accurate indemnity payments, and exceptional customer service. A California Self-Insurance Plan (SIP) certification is required.

Key Responsibilities:

• Investigate and adjust workers' compensation claims from start to finish, maintaining thorough and timely documentation.
• Ensure timely payment of indemnity benefits and adhere to established guidelines.
• Manage diaries efficiently and work towards swift claim closures.
• Provide outstanding customer service to both clients and claimants.
• Potential travel to Irvine, CA for training and claim reviews.

Nice-to-Have Skills:

• Strong time management skills with the ability to prioritize tasks.
• Experience handling indemnity benefits and ensuring timely payments.
• Proficiency in managing diaries and working towards effective closures.

Performance Measurement: Success in this role is evaluated through timely payment of indemnity benefits, customer satisfaction, efficient claim closures, and effective diary management.

If you're a dedicated professional with a commitment to quality claims handling and great customer service, we want to hear from you!

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.)
• Review and maintain personal diary on claim system.
• Assess and monitor subrogation claims for resolution.
• Prepare reports detailing claim status, payments and reserves, as requested.
• Provide notices of qualifying claims to excess/reinsurance carriers.
• Conduct claim reviews and/or training sessions for clients, as requested.
• Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.
• Performs other duties as assigned.

Qualifications:

• Excellent oral and written communication skills.
• Initiative to set and achieve performance goals.
• Good analytic and negotiation skills.
• Ability to cope with job pressures in a constantly changing environment.
• Knowledge of all lower level claim position responsibilities.
• Must be detail oriented and a self-starter with strong organizational abilities.
• Ability to coordinate and prioritize required.
• Flexibility, accuracy, initiative and the ability to work with minimum supervision.
• Discretion and confidentiality required.
• 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

8+ years claim experience within CA jurisdiction is required.

Computer Skills

Proficient using Microsoft Office.

Certificates, Licenses, Registrations

AIC designation 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 included Medical, Dental, Vision, Prescription Drug, Flexible Spending, Life, ESOP and 401K.

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