Workers' Compensation Claim Consultant

CCMSI
Any Location, FL
Category Engineering
Job Description
CCMSI is seeking an experienced Workers' Compensation Claim Consultant to manage a complex portfolio of claims with confidence, empathy, and sound professional judgment. The ideal candidate will have 5+ years of hands-on claims experience, a detail-driven problem-solving approach, and strong communication skills. As a Claim Consultant, you will play a key role in delivering exceptional service to CCMSI clients and upholding our high standards of quality and responsiveness.

Requirements

  • 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 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.
  • 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.
  • Compute AWW/CR from wage statements 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.

Benefits

  • 4 weeks (Paid time off that accrues throughout the year in accordance with company policy) + 10 paid holidays in your first year
  • Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance
  • Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP)
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