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CCMSI

TPA for workers' comp and self-insurance

Workers' Compensation Claims Adjuster

Claims AdjudicationPosted on Nov 13
Full-timeMaitland, FL, USA$70k - $90k

About the Job

Requirements

  • Five or more years of Workers’ Compensation claims experience.
  • Proficiency with Microsoft Office products, including Word, Excel, and Outlook.
  • An adjuster’s license and experience in Florida are required.
  • A bachelor’s degree is preferred but not required.
  • Spanish bilingual proficiency is valued but not required.

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, including legal, surveillance, and case-management vendors.
  • Assess and monitor subrogation claims through resolution.
  • Review and maintain a personal diary in the claim system.
  • Maintain client satisfaction.
  • 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 and reinsurance carriers.
  • Handle more complex claims than lower-level claim positions with minimal 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.

Desired Qualifications

  • Spanish bilingual proficiency for communicating with claimants, employers, or vendors is highly valued but not required.
  • A bachelor’s degree is 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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