Workers' Compensation Claim Consultant, Senior

Overview

Position Title: Workers’ Compensation Claim Consultant, SeniorWork Arrangement: Fully RemoteSchedule: Monday–Friday, 8:00 AM to 4:30 PM PSTSalary Range: $80,000-$95,000License/Certification Required: SIP designation or CA Designation of Workers' Compensation Adjuster required

 

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.

Are you an experienced Workers' Compensation Claim Adjuster with a passion for delivering top-tier customer service? CCMSI is seeking a fully remote Senior Claim Consultant to manage a caseload of workers' compensation claims across multiple accounts in the California jurisdiction. This role involves handling claims from onset to closure, ensuring timely documentation, accurate indemnity payments, and exceptional customer service. A California Self-Insurance Plan (SIP) certification is required.

 

Key Responsibilities:

• Investigate and adjust workers' compensation claims from start to finish, maintaining thorough and timely documentation.
• Ensure timely payment of indemnity benefits and adhere to established guidelines.
• Manage diaries efficiently and work towards swift claim closures.
• Provide outstanding customer service to both clients and claimants.
• Potential travel to Irvine, CA for training and claim reviews.

Nice-to-Have Skills:

• Strong time management skills with the ability to prioritize tasks.
• Experience handling indemnity benefits and ensuring timely payments.
• Proficiency in managing diaries and working towards effective closures.

Performance Measurement: Success in this role is evaluated through timely payment of indemnity benefits, customer satisfaction, efficient claim closures, and effective diary management.

 

If you're a dedicated professional with a commitment to quality claims handling and great customer service, we want to hear from you!

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.)
• Review and maintain personal diary on claim system.
• Assess and monitor subrogation claims for resolution.
• Prepare reports detailing claim status, payments and reserves, as requested.
• Provide notices of qualifying claims to excess/reinsurance carriers.
• Conduct claim reviews and/or training sessions for clients, as requested.
• Attend and participate at hearings, mediations, and informal l