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CCMSI

TPA for workers' comp and self-insurance

Workers' Compensation Claim Specialist - TPA

Claims AdjudicationUpdated on Nov 5
Full-time$75k - $95k

About the Job

Requirements

  • At least 5 years of Colorado workers' compensation claims handling experience, including full claim investigation, evaluation, and resolution, and handling indemnity claims.
  • A Colorado adjuster's license is required.
  • Ability to make assertive claim decisions and manage difficult conversations.
  • Ability to balance compassion and empathy with sound claim management practices.
  • Responsiveness to internal and external client needs.
  • Strong analytical and negotiation abilities.
  • Knowledge of all lower-level claim position responsibilities.

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 according to claim procedures and industry standards, within established payment authority.
  • Negotiate settlements in accordance with Corporate Claim Standards, client-specific handling instructions, and state laws, when appropriate.
  • Assist in selecting and referring designated claim files to outside vendors, and supervise those files, including legal, surveillance, and case management matters.
  • Review and maintain a personal diary in the claim system.
  • Assess and monitor subrogation claims for resolution.
  • Compute disability rates in accordance with state laws.
  • Coordinate timely communication 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

  • Experience handling Utah claims.
  • Bilingual Spanish proficiency for communicating with claimants, employers, or vendors.
  • A bachelor's degree.
  • Professional designations such as AIC.

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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