Workers' Compensation Complex Claims Adjuster

Ccmsi • Dublin, OH

16h • $60,000 - $65,000 • Hybrid

About The Position

At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success. We don’t just process claims—we support people. As the largest privately owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work®, and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day.

We are seeking an experienced Workers’ Compensation Claim Consultant with 5+ years of hands-on workers’ compensation claim experience to manage a dedicated client account. In this role, you will lead full-scope claim investigations, guide strategy, drive timely and accurate claim resolution, and partner closely with both internal teams and client stakeholders. This position requires strong technical knowledge, independent judgment, and the ability to excel in a fast-paced, high-volume environment.

Disclosure: This is a true workers’ compensation claims adjuster position, cradle-to-grave, within a fast‑paced TPA environment. This role is hybrid, reporting to the Dublin, OH branch, with 2–3 days in office per week following the initial training period.

Requirements

• 5+ years of workers’ compensation claims handling experience
• Ability to independently manage a full caseload of WC claims from initial report through resolution
• Strong knowledge of compensability investigation, medical management, reserving, and litigation oversight
• Experience interpreting state WC laws, benefit structures, and regulatory timelines
• Ability to communicate effectively with injured workers, employers, attorneys, medical providers, and client representatives
• Strong documentation, organization, and time‑management skills
• Ability to consistently meet deadlines and quality standards in a fast‑paced environment
• Proficiency with claim management software and Microsoft Office
• Ability to exercise sound, defensible judgment and maintain professionalism under pressure

Nice To Haves

• Experience working within a TPA environment is helpful
• Bachelor’s degree is preferred but not required.
• 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
• 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