Workers Compensation Claims Adjuster (KY Dedicated Account)

Workers' Compensation Claim Consultant

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.

Responsibilities

When we hire Workers' Compensation Adjusters at CCMSI, we look for detail-driven problem-solvers who balance empathy with sound judgment, navigate complex regulations with confidence, and deliver fair, timely outcomes that support injured workers and strengthen client trust.

• 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.

Required Qualifications

• 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

Preferred Qualifications

• 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

Why You'll Love Working Here

• 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

At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by:

• 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

This is where we shine, and we hire adjusters who want to shine with us.

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.

Our Core Values

At CCMSI, we believe in doing what's rightfor our clients, our coworkers, and ourselves. We look for team members who:

• Lead with transparency We build trust by being open and listening intently in every interaction.
• Perform with integrity We choose the right path, even when it is hard.
• Chase excellence We set the bar high and measure our success. What gets measured gets done.
• Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own.
• Win together Our greatest victories come when our clients succeed.

We don't just work togetherwe grow together. If that sounds like your kind of workplace, we'd love to meet you.