Workers' Compensation Claim Specialist
Location: Las Vegas
Posted on: November 26, 2022
At CCMSI, we look for the best and brightest talent to join our
team of professionals. As a leading Third Party Administrator in
self-insurance services, we are united by a common purpose of
delivering exceptional service to our clients. As an Employee-Owned
Company, we focus on developing our staff through structured career
development programs, rewarding and recognizing individual and team
efforts. 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
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
The Workers' Compensation Claim Specialist is responsible for the
investigation and adjustment of assigned claims. This position may
be used as an advanced training position for promotion
consideration for supervisory/management positions. The Claim
Representative is accountable for the quality of claim services as
perceived by CCMSI clients and within our corporate claim
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,
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.
Compute disability rates in accordance with state laws.
Effective and timely coordination of communication with clients,
claimants and other appropriate parties throughout the claim
Provide notices of qualifying claims to excess/reinsurance
Compliance with Corporate Claim Handling Standards and special
client handling instructions as established.
Performs other duties as assigned.
To perform this job successfully, an individual must be able to
perform each essential duty satisfactorily. The requirements listed
below are representative of the knowledge, skills, and/or abilities
required. Reasonable accommodations may be made to enable
individuals with disabilities to perform the essential
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
Knowledge of all lower level claim position responsibilities.
Must be detail oriented and a self-starter with strong
Ability to coordinate and prioritize required.
Flexibility, accuracy, initiative and the ability to work with
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
Ten years claims experience is required.
Bachelor degree is preferred.
Proficient using Microsof Office products such as Word, Excel,
Certificates, Licenses, Registrations
Adjuster's license may be required based upon jurisdiction.
AIC, ARM OR CPCU Designation preferred.
The physical demands described here are representative of those
that must be met by an employee to successfully perform the
essential functions of this job. Reasonable accommodations may be
made to enable individuals with disabilities to perform the
Object Handling Categories
Work requires the ability to lift/carry objects routinely as
Light Lifting: No lifting of objects weighing more than 15 pounds
on a regular basis.
Other Physical Demands
Work requires the ability to stoop, bend, reach and grab with arms
and hands, manual dexterity.
Work requires the ability to sit or stand up to 7.5 or more hours
at a time.
Work requires sufficient auditory and visual acuity to interact
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
Keywords: CCMSI, Las Vegas , Workers' Compensation Claim Specialist, Other , Las Vegas, Nevada
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