Workers' Compensation Claim Consultant (Hybrid)

• 
  
• 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.
  
  
  The Workers' Compensation Claim Consultant is responsible for the investigation and adjustment of assigned claims. - This position is accountable for the quality of claim services as perceived by CCMSI clients and within our corporate claim standards.
  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.
    
    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
    Adjuster's license is 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.
    

Didn't find what you're looking for? Search again!

• Let Irvine recruiters find you. Post your resume for free!
• Get Irvine Professions jobs via email.


• View more Irvine Professions jobs