Professional Liability-Medical Adjusting Specialist

Overview

Position Title: Professional Liability-Medical Adjusting Specialist

Location: Maitland, FL (Hybrid reporting)

Schedule: 8:00 am-4:30 pm ET

Salary Range: $87,500-$90,000

 

 

Build Your Career With Purpose at CCMSI

 

At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success.

 

We don’t just process claims—we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work®, and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day.

 

We are seeking a Multi-Line, Professional Liability, Medical Claim Adjusting Specialist for our hybrid position based in our Maitland, FL office. This role manages a dedicated client account and is responsible for investigating and adjusting a variety of claims, including General Liability, Auto, Property Damage, Professional Liability, and Sexual Abuse/Misconduct Liability.   

 

*A plus will be experience handling claims for organizations and professionals that provide social services. i.e., foster care, behavior facilities

 

Responsibilities

• Investigate, evaluate and adjust multi-line 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 multi-line claims. Negotiate any disputed bills or invoices for resolution.
• Authorize and make payments of multi-line 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 multi-line 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 multi-line claim adjustment process.
• Provide notices of qualifying claims to excess/reinsurance carriers.
• Compliance with Corporate Claim Handling Standards and special client handling instructions as established.

 

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 Experience    

10+ years multi-line claim experience is required.

Bachelor’s Degree is preferred.

Active Adjuster's License: FL

 

 

Nice to Have:

• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.

 

Why You’ll Love Working Here

 

• 4 weeks (<