Workers' Compensation Claim Adjuster

Ccmsi • Nashville, TN

3d • Hybrid

About The Position

CCMSI is hiring a Workers' Compensation Claim Adjuster to investigate, evaluate, administer, and resolve claims across multiple national account programs. The position manages claims from assignment through closure in compliance with applicable state regulations, client handling requirements, and CCMSI claim handling standards. The adjuster will manage approximately 100–125 moderately complex claims, including litigated files, primarily in Tennessee, Georgia, North Carolina, and South Carolina. The role calls for independent claim inventory management, effective communication with injured workers and stakeholders, and consistent delivery of quality claim outcomes.

The position is based in Nashville, Tennessee, with remote work available for qualified candidates and a hybrid option involving approximately two days per week in the Nashville office. The schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m. The salary range is $60,000–$85,000 annually; the role may also qualify for bonuses or other forms of pay. Actual compensation depends on qualifications, experience, geographic location, and internal equity.

CCMSI describes itself as the largest privately owned third-party administrator and a certified Great Place to Work. The company emphasizes employee ownership, collaborative problem-solving, client service, and supporting people through claim solutions. Success is evaluated through claim quality, compliance and audit performance, timeliness and accuracy, client partnership, professional judgment, and cultural alignment.

Requirements

• At least 5 years of Workers' Compensation claims handling experience is listed as preferred.
• Active Georgia Workers' Compensation Adjuster License, or ability to obtain it if applicable.
• Experience managing claims from investigation through resolution.
• Experience handling indemnity claims.
• Strong understanding of Workers' Compensation claim practices and regulations.
• Experience establishing reserves and evaluating claim exposure.
• Ability to independently manage a caseload of 85–125 claims.
• Experience handling litigated claims.
• Strong written and verbal communication skills.
• Effective negotiation and problem-solving abilities.
• Strong organizational, diary management, and time-management skills.
• Proficiency with Microsoft Office applications, including Outlook, Word, and Excel.
• Reliable attendance during established business hours.

Nice To Haves

• Experience handling Tennessee, Georgia, North Carolina, and South Carolina Workers' Compensation claims.
• Prior third-party administrator (TPA) experience.
• Experience supporting national account clients.
• Multi-jurisdictional Workers' Compensation experience.
• Professional designations such as AIC, CPCU, ARM, or WCP.
• Bilingual Spanish proficiency, highly valued but not required.

Responsibilities

• Investigate, evaluate, and adjust claims according to established claim handling standards and applicable laws.
• Establish reserves or provide reserve recommendations within established authority levels.
• Review and approve, or provide oversight of, medical, legal, damage estimate, and miscellaneous invoices to determine whether they are reasonable and related to the claims; negotiate disputed bills or invoices for resolution.
• Authorize and make claim payments in accordance with claim procedures, industry standards, and established payment authority.
• Negotiate settlements when appropriate, in accordance with corporate standards, client-specific instructions, and state laws.
• Assist with selection, referral, and supervision of claim files assigned to outside vendors, including legal, surveillance, and case management providers.
• Assess and monitor subrogation claims for resolution.
• Review and maintain a personal diary in the claim system.
• Support client satisfaction and prepare reports on claim status, payments, and reserves as requested.
• Compute disability rates in accordance with state laws.
• Coordinate timely and effective communication with clients, claimants, and other appropriate parties throughout the claim adjustment process.
• Prepare newsletter articles as requested.
• Provide notices of qualifying claims to excess or reinsurance carriers.
• Handle more complex claims than lower-level claim positions with minimal supervision.
• Conduct claim reviews or training sessions for designated clients as requested.
• Attend and participate in hearings, mediations, and informal legal conferences as appropriate.
• Comply with corporate claim handling standards and established special client handling instructions.

Benefits

• Four weeks of paid time off, accruing throughout the year in accordance with company policy.
• 10 paid holidays in the first year.
• Medical insurance.
• Dental insurance.
• Vision insurance.
• Life insurance.
• Disability insurance.
• 401(k) retirement plan.
• Employee Stock Ownership Plan (ESOP).
• Internal training and advancement opportunities.
• Supportive, team-based work environment.
• The role may qualify for bonuses or additional forms of pay.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed