Job Description

Are you looking to launch a rewarding career in insurance claims? Join our LevelUP Career Pathways Program at CCMSI as a Workers' Compensation Claim Associate I (LevelUP). This role is designed for individuals eager to progress through our structured training program towards becoming a skilled Claim Representative.

Why Choose Claims Adjusting?

• Make a Positive Difference: help individuals and families overcome setbacks by supporting their recovery and rehabilitations through your work.
• Career Growth Opportunities: from entry-level positions to leadership positions, there are endless possibilities.
• Flexible schedules in a hybrid work environment
• Excellent pay and benefits

What Do Claims Adjusters Do?

• Problem Solve Each Day: help people return to work after accidents and recover from natural disasters
• Investigate: interview witnesses, assess damages and negotiate settlements
• Communicate: Interact with clients, injured workers and attorneys in a team environment

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.

As a Claim Associate I LevelUP , you'll handle the initial phases of claims investigation and evaluation. Under close supervision, you'll focus on non-litigated indemnity cases and contested medical-only claims. Your responsibilities include setting up claim files, coordinating medical treatments, and managing communications with clients and claimants.

• Investigate, evaluate and adjust medical only claims, contested medical-only claims and handle a maximum of 30 indemnity claims under direct supervision.
• Establish reserves and/or provide reserve recommendations within established authority levels under direct supervision.
• Set up designated claim files and complete all set up instructions, as requested.
• Set up independent medical exams as deemed necessary under direct supervision.
• Request and monitor medical treatment of designated claims in accordance with corporate claim standards.
• Review and approve related medical, legal, damage estimates and miscellaneous invoices on designated claims. Negotiate any disputed bills/invoices for resolution under direct supervision.
• As appropriate, make referrals to outside vendors on designated cases under direct supervision. (i.e., legal surveillance, case management, etc.)
• Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the claim adjustment process.
• Authorize and make payments on claims utilizing a claim payment program in accordance with industry standards and within established authority levels under direct supervision.
• Compute disability rates in accordance with state laws under direct supervision, when appropriate.
• Summarize all correspondence and medical records in claim log notes as well as file same in the appropriate claim.
• Review and maintain personal diary on claim system.
• Provide technical and clerical claims support to designated clients, as requested.
• Compliance with corporate claim standards and special client handling instructions as established.
• Will act as a back-up to designated adjusters when needed.
• Performs other duties as assigned.

This position is designated for the LevelUP Career Pathway Program which is a career pathway position designed to provide training for consideration as a Claim Representative. In order to be successful in this position, the candidate must possess the following skills and attributes:

• An interest in building a career in insurance claims.
• Excellent oral and written communication skills.
• Excellent organization and time management abilities.
• Individual must be a self-starter.
• Critical thinking skills and the ability to work independently.
• Ability to coordinate and prioritize required with exceptional time management.
• Ability to operate general office equipment and perform clerical duties.
• 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 Experience

Associates degree or two years related business experience preferred.

Knowledge of medical terminology preferred.

Commitment and willingness to learn roles with increasing decision making authority and responsibilities.

Computer Skills

Proficient with Microsoft Office programs.

Certificates, Licenses, Registrations

Must pass Adjuster license exam as required for the respective jurisdiction(s) within the first 60 days of employment.

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 including Medical, Dental, Prescription Drug, Vision, Flexible Spending, Life, ESOP and 401K.

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