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CCMSI

TPA for workers' comp and self-insurance

Workers' Compensation Claim Specialist

Claims AdjudicationPosted on Nov 5
Full-timeCharlotte, NC, USA$70k - $90kIn-person

About the Job

Requirements

  • At least 10 years of workers' compensation claims handling experience, including full claim investigation, evaluation, and resolution.
  • Be responsive to internal and external client needs.
  • Have strong analytical and negotiation abilities.
  • Know the responsibilities of all lower-level claim positions.
  • Hold an adjuster's license if required by the jurisdiction.

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, and 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.
  • Review and maintain a personal diary in the claim system.
  • Assess and monitor subrogation claims through resolution.
  • Compute disability rates in accordance with state laws.
  • Coordinate communication effectively and in a timely manner with clients, claimants, and other appropriate parties throughout the claim adjustment process.
  • Provide notices of qualifying claims to excess or reinsurance carriers.
  • Comply with corporate claim handling standards and special client handling instructions.

Desired Qualifications

  • Bilingual Spanish proficiency is valued for communicating with claimants, employers, or vendors, but is not required.
  • A bachelor's degree is preferred but not required.
  • Professional designations such as AIC, ARM, or CPCU are preferred but not required.

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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