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CCMSI · 5 days ago

Workers' Compensation Claim Specialist (NH, VT)

Manchester, NH

Full-time

Hybrid

Mid, Senior Level

$85K/yr - $92K/yr

5+ years exp

CCMSI is a leading Third Party Administrator in self-insurance services, focused on delivering exceptional service to clients. The Workers' Compensation Claim Consultant is responsible for the investigation and adjustment of assigned claims while ensuring compliance with corporate standards and client satisfaction.

Financial ServicesInsuranceRetail

No H1B

Responsibilities

Investigate, evaluate and adjust claims in accordance with established claim handling standards and laws

Establish reserves and/or provide reserve recommendations within established reserve authority levels

Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated claims. Negotiate any disputed bills or invoices for resolution

Authorize and make payments of claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority

Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate

Assist in the selection, referral and supervision of designated claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.)

Assess and monitor subrogation claims for resolution

Review and maintain personal diary on claim system

Client satisfaction

Prepare reports detailing claim status, payments and reserves, as requested

Compute disability rates in accordance with state laws

Effective and timely coordination of communication with clients, claimants and appropriate parties throughout the claim adjustment process

Prepare newsletter articles, as requested

Provide notices of qualifying claims to excess/reinsurance carriers

Handle more complex and involved claims than lower level claim positions with minimum supervision

Conduct claim reviews and/or training sessions for designated clients, as requested

Attend and participate at hearings, mediations, and informal legal conferences, as appropriate

Compliance with Corporate Claim Handling Standards and special client handling instructions as established