What are the responsibilities and job description for the Workers' Compensation Claim Consultant (NJ/PA/DE Claims) (Remote) position at CCMSI?
Overview
At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts. Certified as a Great Place To Work, our employee satisfaction and retention ranks in the 95th percentile.
Reasons you should consider a career with CCMSI:
- Culture: Our Core Values are embedded into our culture of how we treat our employees as a valued partner-with integrity, passion and enthusiasm.
- Career development: CCMSI offers robust internships and internal training programs for advancement within our organization.
- Benefits: Not only do our benefits include 4 weeks paid time off in your first year, plus 10 paid holidays, but they also include Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP.
- Work Environment: We believe in providing an environment where employees enjoy coming to work every day, are provided the resources needed to perform their job and claims staff are assigned manageable caseloads.
Position: Workers' Compensation Claim Consultant (NY Jurisdiction) Location: Hybrid or Remote (depending on your location) Operational Hours: Monday through Friday, 8am to 4:30pm
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.
- Performs other duties as required.
Qualifications
- Education and/or Experience: Minimum of five years of claims experience.
- Computer Skills: Proficiency in Microsoft Office products such as Word, Excel, Outlook, etc.
- Certificates, Licenses, Registrations: NY adjusters license preferred. Experience with NY/NJ/PA or DE Workers' Compensation claims required.
CORE VALUES & PRINCIPLES:
As a CCMSI team member, you will be responsible for upholding our Core Values & Principles, including:
- Performing with integrity
- Passionately focusing on client service
- Embracing a client-centered vision
- Maintaining contagious enthusiasm for our clients
- Seeking the best ideas
- Viewing change as an opportunity
- Insisting upon excellence
- Creating an atmosphere of excitement, informality, and trust
- Focusing on the situation, issue, or behavior, not the person
