Workers' Compensation Claim Specialist

Workers' Compensation Claim Specialist Location: Albuquerque, NM Schedule: 8:00 am - 4:30 pm (MST) – Hybrid schedule after training period – 2 days in office, 3 days working from home Salary Range: $70,000 - $85,000 (depending on experience) Job Summary: 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 hearings 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. However, 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. 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. Excellent documentation, organization, and communication skills, particularly in legal or quasi-legal environments. 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.) 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. Qualifications Required: 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 Have: 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. 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. How We Measure Success Quality claim handling – thorough investigations, strong documentation, well-supported decisions. Compliance & audit performance – adherence to jurisdictional and client standards. Timeliness & accuracy – purposeful file movement and dependable execution. Client partnership – proactive communication and strong follow-through. Professional judgment – owning outcomes and solving problems with integrity. Cultural alignment – believing every claim represents a real person and acting accordingly. Compensation & Compliance The posted salary reflects CCMSI’s good‑faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay. CCMSI offers comprehensive benefits including medical, dental, vision, life, and disability insurance. Paid time off accrues throughout the year in accordance with company policy, with paid holidays and eligibility for retirement programs in accordance with plan documents. Visa Sponsorship CCMSI does not provide visa sponsorship for this position. ADA Accommodations CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. Equal Opportunity Employer CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations. Background Checks Background checks, if required for the role, are conducted only after a conditional offer and in accordance with applicable fair chance hiring laws. #J-18808-Ljbffr CCMSI