Note: The job is a remote job and is open to candidates in USA. CCMSI is a leading Third Party Administrator specializing in risk management solutions, and they are seeking an experienced Workers' Compensation Claim Consultant. This role involves managing a complex portfolio of claims, leading investigations, guiding claim strategy, and ensuring timely resolutions while delivering exceptional service to clients.
Responsibilities
- Investigate, evaluate, and adjust claims in compliance with company standards and applicable laws
- Establish and manage reserves within authority guidelines
- Review, approve, and negotiate medical, legal, damage estimate, and related claim expenses
- Authorize claim payments and negotiate settlements within established authority and client-specific guidelines
- Coordinate and oversee external vendors, including legal counsel, surveillance, and case management providers
- Monitor claim progression, including subrogation opportunities, diary management, and reporting requirements
- Maintain timely communication with clients, claimants, and other stakeholders throughout the claim lifecycle
- Provide claim status updates, reserve analyses, and other reports as requested
- Calculate disability rates and ensure compliance with applicable state regulations
- Notify excess and reinsurance carriers of qualifying claims
- Handle complex claims independently with minimal supervision
- Participate in hearings, mediations, legal conferences, client meetings, training sessions, and claim reviews, as appropriate
- Support client satisfaction through responsive service and adherence to corporate claim handling standards and client instructions
- Contribute to special projects, training materials, newsletters, and other departmental initiatives as requested
Skills
- 5+ years of California Workers' Compensation claims experience
- Proficiency with Microsoft Office products, including Word, Excel, and Outlook
- SIP is required, or you must be able to obtain
- Experience handling a mostly litigated workload
- Bachelor's degree is preferred but not required
- Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required
Benefits
- 4 weeks (Paid time off that accrues throughout the year in accordance with company policy) + 10 paid holidays in your first year
- Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance
- Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP)
- Internal training and advancement opportunities
- Supportive, team-based work environment
Company Overview