Remote Workers' Compensation Claim Adjuster – California Claims Specialist - Irvine

Overview:

As part of our Employee-Owned Company, you'll join a team committed to exceptional service, innovation, and continuous growth in self-insurance.

What You Can Expect at CCMSI:

• Culture: We are guided by our Core Values, ensuring a supportive environment that values integrity, passion, and enthusiasm.
• Career Development: Enjoy robust training programs and opportunities for advancement.
• Comprehensive Benefits: In addition to 4 weeks of paid time off, 10 paid holidays, and a range of health, disability, and retirement benefits, we offer an Employee Stock Ownership Plan (ESOP).
• Work Environment: With manageable caseloads and resources at your disposal, CCMSI strives to create an enjoyable and supportive work atmosphere.

As a Workers' Compensation Claim Consultant, Senior, you will investigate and adjust claims with a commitment to quality, delivering outstanding service that meets both CCMSI's standards and the expectations of our valued clients.

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.

Computer Skills

Proficient using Microsoft Office.

Certificates, Licenses, Registrations

Adjuster's Certificate is preferred but not 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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