[Hiring] Workers' Compensation Claim Representative II @CCMSI

Role Description

We are seeking an experienced and motivated Workers’ Compensation Claim Representative II to manage a portfolio of Texas workers’ compensation claims with professionalism, empathy, and sound decision-making. With 5+ years of claims experience, you'll investigate claims, make compensability decisions, and drive timely, effective resolutions. This role handles moderately complex claims across multiple accounts and industries, making it a great fit for someone who enjoys variety and can easily adapt to different client needs. As part of our commitment to flexibility, you'll have the ability to work remotely from day one. You'll play a key role in delivering an exceptional client experience while continuing to grow your technical expertise and advance your claims career with CCMSI.

Responsibilities

• Investigate and adjust workers compensation claims in accordance with established claims handling procedures using CCMSI guidelines and direct supervision.
• Review medical, legal and miscellaneous invoices to determine if reasonable and related to the ongoing workers compensation claims. Negotiate any disputed bills for resolution.
• Authorize and make payment of workers compensation claims utilizing a claim payment program in accordance with industry standards and within settlement authority.
• Negotiate settlements with claimants and attorneys in accordance with client's authorization.
• Assist in selection and supervision of defense attorneys.
• Assess and monitor subrogation claims for resolution.
• Prepare reports detailing claims, payments and reserves.
• Provide reports and monitor files, as required by excess insurers.
• Compliance with Service Commitments as established by team.
• Delivery of quality claim service to clients.

Qualifications

• Excellent oral and written communication skills.
• Self-starter with strong organizational skills and the ability to work with minimal supervision.
• Texas Adjusting License is Required.
• Proven ability to coordinate, prioritize, and manage multiple responsibilities.
• Flexibility, initiative, and adaptability in a fast-paced, rapidly changing environment.
• Strong discretion and ability to maintain confidentiality.
• Ability to work effectively as part of a team.
• Reliable, predictable attendance within client service hours.
• Responsiveness to internal and external client needs.
• Ability to communicate clearly and professionally, both verbally and in writing.
• 5+ years of Texas Workers’ Compensation claims management experience or equivalent combination of experience and education.
• Proficiency with Microsoft Office programs (Word, Excel, Outlook, etc.).

Requirements

• Associate degree is preferred but not required.
• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.

Benefits

• 4 weeks of 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).
• Career growth: Internal training and advancement opportunities.
• A supportive, team-based work environment.