Senior Workers' Comp Claim Consultant (Hybrid)

CCMSI; Reading (MA); Hybrid; USD 85,000 - 95,000; Full time

Benefits offered by this job

PTO: 4 weeks

Comprehensive benefits

401(k) with ESOP

Career growth opportunities

Job summary

CCMSI, Reading, MA, seeks an experienced Workers’ Compensation Claim Consultant to manage a complex portfolio with confidence, empathy, and sound judgment. This role requires 5+ years of hands-on WC claims experience and offers a clear path to senior positions.

You will conduct thorough investigations, set reserves, review medical and legal bills, negotiate settlements, and coordinate with clients, claimants, and vendors in a hybrid work model after training.

Qualifications

• Five or more years of Workers’ Compensation claims experience.
• Proficiency with Microsoft Office products, including Word, Excel, and Outlook.
• Adjuster’s license: CT, RI

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 with Corporate Claim Standards, client instructions and state laws, when appropriate.
• Assist in the selection, referral and supervision of designated claim files sent to outside vendors (e.g., legal, surveillance, case management).
• Assess and monitor subrogation claims for resolution.
• Review and maintain personal diary on claim system.
• Prepare reports detailing claim status, payments and reserves.
• Compute disability rates in accordance with state laws.
• Coordinate communication with clients, claimants and appropriate parties throughout the claim adjustment process.
• Provide notices of qualifying claims to excess/reinsurance carriers.
• Handle more complex claims with minimum supervision.
• Conduct claim reviews or training sessions for designated clients.
• Attend hearings, mediations, and informal legal conferences, as appropriate.
• Compliance with Corporate Claim Handling Standards and client instructions

Skills

WC claims

Microsoft Office

Adjuster license CT/RI

Education

Bachelor's degree (preferred)

Job description

CCMSI, Reading, MA, seeks an experienced Workers’ Compensation Claim Consultant to manage a complex portfolio with confidence, empathy, and sound judgment. This role requires 5+ years of hands-on WC claims experience and offers a clear path to senior positions.

You will conduct thorough investigations, set reserves, review medical and legal bills, negotiate settlements, and coordinate with clients, claimants, and vendors in a hybrid work model after training.