Workers' Compensation Claim Consultant

Ccmsi • Las Vegas, NV

1d • Hybrid

About The Position

We are seeking an experienced and highly skilled Workers’ Compensation Claim Consultant to manage a complex portfolio of claims with confidence, empathy, and sound professional judgment. In this role, you will serve as the dedicated claims professional for a single municipal account, building strong client relationships while delivering exceptional service and support. With 5+ years of hands-on claims experience, you will lead thorough investigations, guide claim strategy, and ensure fair, timely resolutions. This client places a high value on responsiveness, accuracy, and attention to detail, making this an excellent opportunity for a confident and knowledgeable communicator who exercises sound judgment and knows when to seek clarification to ensure accurate information is provided. This role also offers a strong development pathway for advancement into more senior claim positions. This is a full life‑cycle WC adjuster position within a TPA environment, and only candidates with proven Workers’ Compensation claims experience will be considered.

Requirements

• Five or more years of Workers’ Compensation claims experience.
• Nevada Workers' Compensation Adjuster License or ability to obtain it.
• Proven capability to build trust with clients through professionalism, accountability, and a commitment to delivering high-quality service.
• Experience handling medical only and lost time claims.
• Must be able to commute to the Las Vegas branch office.
• Proficiency with Microsoft Office products, including Word, Excel, and Outlook.

Nice To Haves

• Bachelor’s degree is preferred but not required.
• Experience handling municipal accounts.
• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.

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.

Benefits

• 4 weeks (Paid time off that accrues throughout the year in accordance with company policy)
• 10 paid holidays in your first year
• Medical, Dental, Vision, Life, and Disability Insurance
• 401(k) and Employee Stock Ownership Plan (ESOP)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree