Workers' Compensation Claim Representative I

Ccmsi•Albuquerque, NM

3d•Hybrid

About The Position

The Workers’ Compensation Claim Representative I handles the investigation and adjustment of assigned claims while ensuring high-quality service that meets CCMSI client expectations and company standards. This role also serves as a developmental position, preparing employees for advancement to higher-level claims roles. Experience handling education or educational services is preferred.

Requirements

3+ years of New Mexico Workers’ Compensation claims experience or related insurance industry experience.
Strong organizational skills with the ability to prioritize and manage multiple tasks independently.
Effective verbal and written communication skills for interaction with internal teams, clients, and external partners.
Ability to work collaboratively in a fast-paced, changing environment while maintaining accuracy and confidentiality.
Reliable and predictable attendance during established hours.
Proficiency with Microsoft Office applications (Word, Excel, Outlook).
Active adjuster license in New Mexico or ability to obtain required licensing for New Mexico within 60 days of hire, if applicable.

Nice To Haves

Experience supporting education or educational services Workers’ Compensation claims.
Associate’s degree or higher, or related insurance industry experience.
Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.

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.