Workers' Compensation Claim Specialist

Ccmsi • Albuquerque, NM

3d • Hybrid

About The Position

We are seeking a driven and compassionate Workers’ Compensation Claim Specialist with experience handling New Mexico Workers' Compensation claims to join our team and make a meaningful impact in the lives of injured workers. In this role, you will take ownership of a dedicated portfolio of claims—leading investigations, determining compensability, and guiding each case toward a fair and timely resolution. Given the nature of the caseload, this position also requires experience managing litigated claims and working closely with legal counsel, including preparing cases for hearing or trial and participating in key legal proceedings. Candidates who bring a strong understanding of workers’ compensation litigation and legal processes will be best positioned to succeed in this role. This position also offers the opportunity to grow your technical expertise and can serve as an advanced development path for future supervisory or management roles. As a Claim Specialist, you play a vital role in delivering the high-quality service our clients count on and upholding CCMSI’s commitment to excellence.

Requirements

• 8+ years of Workers’ Compensation claims handling experience, including full claim investigation, evaluation, and resolution.
• Experience working directly with defense counsel on case strategy and legal proceedings
• Strong working knowledge of workers’ compensation laws and regulatory requirements (New Mexico preferred)
• Demonstrated understanding of legal processes and claim litigation, including hearings and trial preparation
• Responsiveness to internal and external client needs.
• Strong analytical and negotiation abilities.
• Knowledge of all lower-level claim position responsibilities.
• New Mexico Adjuster license is required.

Nice To Haves

• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.
• Bachelor's degree is preferred but not required
• Professional designations such as AIC, ARM, or CPCU are preferred 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 with 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.)
• Review and maintain personal diary on claim system.
• Assess and monitor subrogation claims for resolution.
• Compute disability rates in accordance with state laws.
• Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the claim adjustment process.
• Provide notices of qualifying claims to excess/reinsurance carriers.
• 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
• Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance
• Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP)
• Career growth: Internal training and advancement opportunities
• Culture: A supportive, team-based work environment

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED