Workers' Compensation Claims Adjuster – TN, GA, NC & SC (Hybrid/Remote)

Ccmsi • Nashville, TN

4d • Hybrid

About The Position

The Workers' Compensation Claim Consultant is responsible for the investigation, evaluation, administration, and resolution of Workers' Compensation claims across multiple national account programs. This role manages claims from assignment through closure while ensuring compliance with applicable state regulations, client handling requirements, and CCMSI claim handling standards. The successful candidate will handle a caseload of approximately 85–125 claims with moderate complexity, including litigated files, and will work primarily within the Tennessee, Georgia, North Carolina, and South Carolina jurisdictions. This position is ideal for an experienced Workers' Compensation adjuster who can independently manage a full claim inventory, communicate effectively with injured workers and stakeholders, and consistently deliver quality claim outcomes.

Requirements

• 5+ years of Workers' Compensation claims handling experience preferred
• Active Georgia Workers' Compensation Adjuster License required (or ability to obtain if applicable)
• Experience managing claims from investigation through resolution
• Experience handling indemnity claims
• Strong understanding of Workers' Compensation claim practices and regulations
• Experience establishing reserves and evaluating claim exposure
• Ability to independently manage a caseload of 85–125 claims
• Experience handling litigated claims
• Strong written and verbal communication skills
• Effective negotiation and problem-solving abilities
• Strong organizational, diary management, and time-management skills
• Proficiency with Microsoft Office applications including Outlook, Word, and Excel
• Reliable attendance during established business hours

Nice To Haves

• Experience handling Tennessee, Georgia, North Carolina, and South Carolina Workers' Compensation claims
• Prior TPA experience
• Experience supporting national account clients
• Multi-jurisdictional Workers' Compensation experience
• Professional designations such as: AIC CPCU ARM WCP
• 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: No Education Listed