Workers’ Compensation Claims Adjuster (KY Dedicated Account)

Ccmsi • Louisville, KY

11d • Hybrid

About The Position

The Workers’ Compensation Claim Consultant is responsible for the investigation and adjustment of assigned workers’ compensation claims for a dedicated Kentucky account. This role manages claims from assignment through resolution (cradle to grave), including those with litigation exposure, while ensuring compliance with CCMSI claim handling standards, client-specific instructions, and Kentucky jurisdictional requirements. This position is designed for experienced adjusters with 5+ years of workers’ compensation claim handling experience who are confident managing complex files, applying sound professional judgment, and delivering consistent, high-quality outcomes. The Claim Consultant plays a critical role in achieving strong client satisfaction through responsiveness, accuracy, and strategic claim management. This is a full life-cycle WC adjuster role within a TPA environment, and only candidates with proven workers’ compensation claims experience will be considered.

Requirements

• Minimum of 3 years of workers’ compensation claim handling experience
• Experience managing claims in Kentucky workers’ compensation jurisdiction
• Exposure to litigated workers’ compensation claims
• Strong analytical, decision-making, and negotiation capabilities
• Excellent verbal and written communication skills
• Ability to work independently with strong organizational and time management skills
• Proficiency in Microsoft Office applications
• Reliable, predictable attendance during assigned client service hours

Nice To Haves

• Prior TPA experience
• Experience handling governmental or public entity accounts
• Advanced experience managing complex or high-exposure claims
• Knowledge of KY Managed Care plans is a plus

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.
• 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
• 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: No Education Listed