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CCMSI

TPA for workers' comp and self-insurance

Workers' Compensation Claim Adjuster

Claims AdjudicationUpdated on Nov 5
Full-timeNashville, TN, USA$60k - $85k /yr

About the Job

Requirements

  • An active Georgia Workers' Compensation Adjuster License is required, or the ability to obtain it if applicable.
  • Experience managing claims from investigation through resolution.
  • Experience handling indemnity claims.
  • A strong understanding of Workers' Compensation claim practices and regulations.
  • Experience establishing reserves and evaluating claim exposure.
  • Ability to independently manage a caseload of 85–125 claims.
  • Experience handling litigated claims.
  • Strong written and verbal communication skills.
  • Effective negotiation and problem-solving abilities.
  • Strong organizational, diary management, and time-management skills.
  • Proficiency with Microsoft Office applications, including Outlook, Word, and Excel.
  • Reliable attendance during established business hours.

Responsibilities

  • Investigate, evaluate, and adjust claims in accordance with established claim handling standards and laws.
  • Establish reserves or provide reserve recommendations within established reserve authority levels.
  • Review, approve, or oversee medical, legal, damage estimate, and miscellaneous invoices to determine whether they are reasonable and related to designated claims; negotiate disputed bills or invoices for resolution.
  • Authorize and make claim payments in accordance with claim procedures, using a claim payment program and staying within established payment authority.
  • Negotiate settlements in accordance with Corporate Claim Standards, client-specific handling instructions, and state laws, when appropriate.
  • Assist in selecting, referring, and supervising designated claim files sent to outside vendors, such as legal, surveillance, and case management vendors.
  • Assess and monitor subrogation claims for resolution.
  • Review and maintain a personal diary on the claim system.
  • Prepare reports detailing claim status, payments, and reserves, as requested.
  • Compute disability rates in accordance with state laws.
  • Coordinate communication effectively and promptly with clients, claimants, and appropriate parties throughout the claim adjustment process.
  • Prepare newsletter articles, as requested.
  • Provide notices of qualifying claims to excess or reinsurance carriers.
  • Handle more complex and involved claims than lower-level claim positions with minimum supervision.
  • Conduct claim reviews or training sessions for designated clients, as requested.
  • Attend and participate in hearings, mediations, and informal legal conferences, as appropriate.
  • Comply with Corporate Claim Handling Standards and special client handling instructions.
  • Manage assigned Workers' Compensation claims from assignment through closure, including investigation, evaluation, administration, and resolution across national account programs.
  • Handle a caseload of approximately 100–125 moderately complex claims, including litigated files, primarily within Tennessee, Georgia, North Carolina, and South Carolina jurisdictions.

Desired Qualifications

  • Five or more years of Workers' Compensation claims handling experience is preferred.
  • Experience handling Tennessee, Georgia, North Carolina, and South Carolina Workers' Compensation claims.
  • Prior third-party administrator experience.
  • Experience supporting national account clients.
  • Multi-jurisdictional Workers' Compensation experience.
  • Professional designations such as AIC, CPCU, ARM, or WCP.
  • Spanish proficiency for communicating with claimants, employers, or vendors.

About the Company

CCMSI

TPA for workers' comp and self-insurance

CCMSI provides third-party administration services for workers' compensation and property/casualty self-insurance programs. It manages claims and offers risk management and cost-containment strategies for self-insured entities, including group self-insurance associations. The product works by acting as an administrator for a client’s self-insurance program: handling claims, administering payments, and implementing risk controls and cost-saving measures on a fee basis. CCMSI differentiates itself by focusing on the self-insurance niche and serving organizations that bear their own insurance risks, rather than selling traditional insurance policies. The company’s goal is to help clients reduce claim costs and manage their self-insurance programs more effectively.

Company size
1,001-5,000
Company stage
Not listed
Total funding
Not listed
Headquarters
Danville, IL
Founded
1978

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