Workers' Compensation Claim Specialist, Senior
Company: CCMSI
Location: Las Vegas
Posted on: January 26, 2023
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Job Description:
Overview: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
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 Senior Claim Specialist is
responsible for the investigation and adjustment of assigned
claims. This position may be used as an advanced training position
for consideration for promotion to a supervisory/management
position. 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.Compute disability rates in
accordance with state laws.Effective and timely coordination of
communication with clients, claimants and other appropriate parties
throughout the claim adjustment process.Provide notices of
qualifying claims to excess/reinsurance carriers.Handle more
complex and involved claims than intermediate/lower level claims
positions with minimum supervision, as requested.Attend and
participate at hearings, mediations, and informal legal
conferences, as appropriate.Supervision of all claim activity for
specified accounts.Compliance with Corporate Claim Handling
Standards and special client handling instructions as
established.Performs other duties as assigned.Qualifications: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
functions.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
Experience15+ years claim experience is required.Bachelor Degree is
preferred.Computer SkillsProficient using Microsoft Office programs
such as Word, Excel, Outlook, etc.Certificates, Licenses,
RegistrationsAdjusters license may be required based upon
jurisdictionAIC Designation preferred.Physical DemandsThe 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 essential
functions.Object Handling CategoriesWork requires the ability to
lift/carry objects routinely as follows: Light Lifting: No lifting
of objects weighing more than 15 pounds on a regular basis.Other
Physical DemandsWork 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 with othersCORE VALUES &
PRINCIPLESResponsible 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 including Medical, Dental, Prescription
Drug, Vision, Flexible Spending, Life, ESOP and 401K.
Keywords: CCMSI, Las Vegas , Workers' Compensation Claim Specialist, Senior, Other , Las Vegas, Nevada
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