Workers' Compensation Claim Consultant
Posted on: January 15, 2022
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
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
- 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 Consultant is responsible for the
investigation and adjustment of assigned claims. This position may
be used as an advanced training position for consideration of
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, 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.)
- Assess and monitor subrogation claims for resolution.
- Review and maintain personal diary on claim system.
- Client satisfaction.
- Prepare reports detailing claim status, payments and reserves,
- Compute disability rates in accordance with state laws.
- Effective and timely coordination of communication with
clients, claimants and appropriate parties throughout the claim
- Prepare newsletter articles, as requested.
- Provide notices of qualifying claims to excess/reinsurance
- Handle more complex and involved claims than lower level claim
positions with minimum supervision.
- Conduct claim reviews and/or training sessions for designated
clients, as requested.
- Attend and participate at hearings, mediations, and informal
legal conferences, as appropriate.
- Compliance with Corporate Claim Handling Standards and special
client handling instructions as established.
- Performs other duties as assigned.Qualifications:Education
and/or ExperienceFive or more years claims experience is
required.Bachelor degree is preferred.
Computer SkillsProficient using MicroSoft Office products such as
Word, Excel, Outlook, etc.
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 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 & 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
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, Austin , Workers' Compensation Claim Consultant, Professions , Austin, Texas
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