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Workers' Compensation Claim Consultant

Company

CCMSI
Address , Nashville, 37214, Tn
Employment type FULL_TIME
Salary
Expires 2023-10-04
Posted at 9 months ago
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.
  • 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.
  • Career development: CCMSI offers robust internships and internal training programs for advancement within our organization.

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:
  • 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.
  • Handle more complex and involved claims than lower level claim positions with minimum supervision.
  • Establish reserves and/or provide reserve recommendations within established reserve authority levels.
  • Client satisfaction.
  • 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.
  • Effective and timely coordination of communication with clients, claimants and appropriate parties throughout the claim adjustment process.
  • Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate.
  • Provide notices of qualifying claims to excess/reinsurance carriers.
  • Conduct claim reviews and/or training sessions for designated clients, as requested.
  • Assist in the selection, referral and supervision of designated claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.)
  • Compliance with Corporate Claim Handling Standards and special client handling instructions as established.
  • Performs other duties as assigned.
  • Prepare newsletter articles, as requested.
  • Compute disability rates in accordance with state laws.
  • Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.
  • 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.
  • Investigate, evaluate and adjust claims in accordance with established claim handling standards and laws.
Qualifications:
Education and/or Experience
Five or more years claims experience is required.
Bachelor degree is preferred.

Computer Skills
Proficient using MicroSoft Office products such as Word, Excel, Outlook, etc.

Certificates, Licenses, Registrations
Adjuster's license may be required based upon jurisdiction

Physical Demands
The 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 Categories
Work 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 sit or stand up to 7.5 or more hours at a time.
  • Work requires sufficient auditory and visual acuity to interact with others.
  • Work requires the ability to stoop, bend, reach and grab with arms and hands, manual dexterity.

CORE VALUES & PRINCIPLES
Responsible 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 included Medical, Dental, Vision, Prescription Drug, Flexible Spending, Life, ESOP and 401K.