CCMSI

Claims Specialist

• Investigate, evaluate and adjust Arizona workers’ compensation claims
• Establish reserves and provide reserve recommendations within authority levels
• Review, approve or oversee medical, legal, damage estimate and miscellaneous invoices
• Negotiate disputed bills and invoices
• Authorize and make claim payments using a claim payment program
• Negotiate settlements according to corporate standards, client instructions and state laws
• Select, refer and supervise claim files sent to outside vendors
• Assess and monitor subrogation claims
• Review and maintain claim-system diaries
• Prepare reports detailing claim status, payments and reserves
• Compute disability rates in accordance with state laws
• Coordinate communications with clients, claimants and other parties
• Provide notices of qualifying claims to excess/reinsurance carriers
• Handle complex claims with minimal supervision
• Conduct claim reviews and training sessions for designated clients
• Attend hearings, mediations and informal legal conferences
• Comply with corporate claim-handling standards and client instructions
• Support client satisfaction

Workers' Compensation Claims Adjuster

• Investigate and adjust workers’ compensation claims according to company standards and established claim handling procedures
• Evaluate medical, legal, and related claim documentation to support timely and accurate claim decisions
• Authorize and process claim payments within applicable authority and regulatory requirements
• Negotiate settlements with claimants, attorneys, and other stakeholders
• Coordinate with defense counsel and external service providers to support effective claim resolution
• Prepare claim reports, reserve recommendations, and documentation to maintain claim accuracy and compliance
• Manage claim activities across multiple accounts and industries while meeting service commitments
• Deliver responsive, professional service to clients, injured workers, and business partners

Workers' Compensation Claims Adjuster

Workers’ Compensation Claims Adjuster II