Workers' Compensation Claim Consultant

Ccmsi • Las Vegas, NV

1d • Onsite

About The Position

We are seeking an experienced and highly skilled Nevada Workers’ Compensation Claim Consultant to manage a complex portfolio of claims with confidence, empathy, and sound professional judgment. With 5+ years of hands‑on claims experience, you will lead thorough investigations, guide claim strategy, and ensure fair, timely resolutions. This role also offers a strong development pathway for advancement into more senior claim positions. As a Claim Consultant, you will play a key role in delivering exceptional service to CCMSI clients and upholding our high standards of quality and responsiveness. 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

• 5+ years of Nevada Workers’ Compensation claims experience.
• Nevada adjuster’s license or ability to obtain one.
• Proficiency with Microsoft Office products, including Word, Excel, and Outlook.
• Excellent oral and written communication, negotiation, and interpersonal skills.
• Strong analytical, organizational, and problem-solving abilities with exceptional attention to detail.
• Self-motivated professional with the initiative to set and achieve performance goals.
• Ability to effectively prioritize, coordinate, and manage multiple responsibilities in a fast-paced, evolving environment.
• Demonstrated flexibility, accuracy, and ability to work independently with minimal supervision.
• Knowledge of lower-level workers’ compensation claims functions and responsibilities.
• Ability to maintain confidentiality and exercise sound professional judgment.
• Reliable, predictable attendance during client service hours.

Nice To Haves

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

Responsibilities

• Investigate, evaluate, and adjust claims in accordance with claim handling standards and applicable laws.
• Establish reserves and provide reserve recommendations within assigned authority levels.
• Review and approve medical, legal, damage estimate, and miscellaneous invoices; negotiate disputed charges when necessary.
• Authorize and issue claim payments in accordance with established procedures, industry standards, and payment authority.
• Negotiate claim settlements in compliance with Corporate Claim Standards, client-specific instructions, and state laws.
• Select, refer, and oversee claim files assigned to outside vendors, including legal counsel, surveillance, and case management services.
• Evaluate and monitor subrogation opportunities through resolution.
• Maintain timely and accurate claim diaries and documentation.
• Promote and maintain a high level of client satisfaction.
• Prepare claim status, payment, and reserve reports as requested.
• Calculate disability rates in accordance with state regulations.
• Ensure timely and effective communication with clients, claimants, and other involved parties throughout the claims process.
• Prepare newsletter articles and client communications as requested.
• Provide required notifications to excess and reinsurance carriers.
• Handle complex claims with minimal supervision.
• Conduct claim reviews and training sessions for clients as requested.
• Represent claims at hearings, mediations, and informal legal conferences as appropriate.
• Maintain compliance with Corporate Claim Handling Standards and client-specific handling requirements.

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)
• Internal training and advancement opportunities

What This Job Offers

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