Overview:
Workers' Compensation Claim Consultant (Remote) – California Jurisdiction
At CCMSI, we seek the best and brightest to join our team of professionals. As a leading Third Party Administrator specializing in self-insurance services, we’re committed to delivering exceptional service to our clients. We are proud to be an Employee-Owned Company, dedicated to developing our staff through structured career programs and rewarding individual and team efforts. Certified as a Great Place to Work, our employee satisfaction and retention ranks in the 95th percentile.
Position Overview: We are currently seeking an experienced Workers' Compensation Claim Consultant to handle claims in the state of California. This is a fully remote position, with flexible hours of either 7:00 am to 3:30 pm or 8:00 am to 4:30 pm, Monday through Friday.
Key Requirements:
5+ years of California Workers' Compensation claim handling experience is required.
Must hold a Self-Insurance Plan (SIP) Certificate or California Adjuster Certificate.
Comprehensive knowledge of California Workers' Compensation laws and regulations.
Strong investigative, analytical, and negotiation skills.
Experience in maintaining compliance with statutory requirements and company claim handling standards.
Ability to manage a caseload efficiently while meeting deadlines and maintaining claim quality.
Primary Responsibilities:
Investigate and adjust assigned Workers' Compensation claims in compliance with California laws.
Accurately assess liability and determine appropriate claim resolutions.
Communicate effectively with claimants, clients, medical providers, and legal professionals.
Maintain detailed claim documentation and ensure timely reporting.
Handle claims with a customer-focused approach, upholding the quality of services provided to CCMSI clients.
Why Choose a Career at CCMSI?
Culture: Our core values emphasize integrity, passion, and a positive work environment.
Career Development: CCMSI offers structured training programs and opportunities for growth within the company.
Competitive Benefits: Enjoy 4 weeks of paid time off in your first year, 10 paid holidays, Medical, Dental, Vision, Life Insurance, Critical Illness coverage, Short and Long-Term Disability, 401K, and Employee Stock Ownership Plan (ESOP).
Work Environment: We provide resources for success and ensure that claims staff are assigned manageable caseloads to promote work-life balance.
Take the next step in your career with CCMSI, where your expertise is valued, and your contributions make an impact. Apply today!
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.)
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, as requested.
Compute disability rates in accordance with state laws.
Effective and timely coordination of communication with clients, claimants and appropriate parties throughout the claim adjustment process.
Prepare newsletter articles, as requested.
Provide notices of qualifying claims to excess/reinsurance carriers.
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 Experience
Five Or More Years Claims Experience Is Required.
Computer Skills
Proficient using MicroSoft Office products such as Word, Excel, Outlook, etc.
Certificates, Licenses, Registrations
Must hold a Self-Insurance Plan (SIP) Certificate or California Adjuster Certificate.
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.
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