Workers' Compensation Claim Representative II

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  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 Claim Representative II is responsible for the investigation and adjustment of assigned workers compensation claims. This position may be used as an advanced training position for future consideration for promotion to a more senior level claim position. Accountable for the quality of claim services as perceived by CCMSI clients and within our corporate claim standards.Responsibilities:
  • Investigate and adjust workers compensation claims in accordance with established claims handling procedures using CCMSI guidelines and direct supervision.
  • Review medical, legal and miscellaneous invoices to determine if reasonable and related to the ongoing workers compensation claims. Negotiate any disputed bills for resolution.
  • Authorize and make payment of workers compensation claims utilizing a claim payment program in accordance with industry standards and within settlement authority.
  • Negotiate settlements with claimants and attorneys in accordance with client's authorization.
  • Assist in selection and supervision of defense attorneys.
  • Assess and monitor subrogation claims for resolution.
  • Prepare reports detailing claims, payments and reserves.
  • Provide reports and monitor files, as required by excess insurers.
  • Compliance with Service Commitments as established by team.
  • Delivery of quality claim service to clients.
  • 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.
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      Excellent oral and written communication skills.
    • Individual must be a self-starter with strong organizational abilities.
    • Ability to coordinate and prioritize required.
    • Flexibility, initiative, and the ability to work with a minimum of direct supervision a must.
    • Discretion and confidentiality required.
    • Ability to work as a team member in a rapidly changing environment.
    • 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 ExperienceLevel II Claim Rep will possess excellent claims management skills, typically with 5 to 10 years of experience or equivalent education, along with proven claims handling performance levels.Associates degree is preferred.
      Computer SkillsProficient with Microsoft Office programs.
      Certificates, Licenses, RegistrationsAdjuster's license may be required based upon jurisdiction.
      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 Requirements
      • 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 with others.
        CORE 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.

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