At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts. Certified as a Great Place To Work, our employee satisfaction and retention ranks in the 95th percentile.    

Reasons you should consider a career with CCMSI:

• Culture: Our Core Values are embedded into our culture of how we treat our employees as a valued partner-with integrity, passion and enthusiasm.
• Career development: CCMSI offers robust internships and internal training programs for advancement within our organization.
• Benefits: Not only do our benefits include 4 weeks paid time off in your first year, plus 10 paid holidays, but they also include Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP.
• Work Environment: We believe in providing an environment where employees enjoy coming to work every day, are provided the resources needed to perform their job and claims staff are assigned manageable caseloads.

We are seeking a WC Litigation Specialist for a hybrid position with a dedicated governmental account. This role, reporting to a Supervisor or Manager, involves daily management of Hearing and Appeals tracking, including maintenance of a calendar for upcoming Hearings and Appeals. Responsibilities include ensuring proper assignment, handling, mitigation, or defense of hearings, and other related administrative duties as required. A Nevada adjuster's license is preferred for this position.

Essential Duties & Responsibilities:

• Maintain Hearing and Appeals tracking which includes but is not limited to logging dates, status, and outcome of all hearing and appeals. This responsibility may be shared and/or coordinated with the State Compliance Manager.
• Coordinate with Claim Representative on new matters as assigned.
• For hearings:
  • Ensure the matter is placed on CCMSI’s internal calendar, only remove if the matter is dismissed or assigned to defense counsel.
  • Understand each issue being appealed, discuss the matter with the Claim Representative in order to be aware of all relevant facts and information which lead to the determination being appealed, as well as the current claim status.
  • If there are concerns with the ability to prevail at hearing, discuss those concerns with the Claim Representative and/or Claim Supervisor to come to a mutual agreement.
  • If the issue is moot, work diligently to obtain a dismissal prior to the date of the hearing.
  • If the issue should be resolved, ensure the Claim Representative takes the appropriate action to resolve the matter prior to the date of the hearing.
  • If the issue should be defended, prepare and file a hearing statement, with supporting evidence, at least two business days prior to the date of the hearing or, if applicable, ensure the Claim Representative assigns appropriate defense counsel and provides the file copy at least two weeks prior to the date of the hearing.
  • Enter a Private Legal note to document any new information/arguments orally presented at hearing, any comments made by the hearing officer, and, if applicable, the anticipated outcome of the hearing.
• For Appeals:
  • Ensure the Claim Representative assigns appropriate defense counsel and provides the file copy at least three weeks prior to the date of the appeal. Follow up for results of appeals, and log accordingly in the internal tracking document. When appropriate, discuss strategy on any appeals requiring further action, and collaborate with client and claim representative on next steps, as outlined in Best Practices or client-specific Special Handling Instructions.
• Provide a thorough review and analysis on various matters when requested.
• Ensure that all target dates are met (or exceeded).
• Act as a back up to Compliance Manager for logging litigation dates and outcomes, monitoring and following up for adjuster compliance, and submitting proof of compliance to the DIR.
• Acquire and maintain applicable adjuster licenses, including State of Nevada, Department of Administration, Hearings Division, and Workers ’ Compensation License.
• May require handling of high-level Workers’ Compensation claims.
• Other duties as assigned.

Education and/or Experience

High School Diploma or equivalent

Minimum 7-10 years of Nevada workers’ compensation experience, preferably handling Lost Time and litigated claims

Knowledge of the hearings and appeals process

Computer Skills    

Proficient using Microsoft Office products, such as:   Word, Excel, Outlook, TEAMS, etc.

Certificates, Licenses, Registrations

Nevada Workers’ Compensation Adjuster license is required or must be obtained.

State of Nevada, Department of Administration, Hearings Division, Workers’ Compensation License is required or must be obtained.

CORE VALUES & PRINCIPLES

Responsible for upholding the CCMSI Core Values & Principles which include: performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity; insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better; and leading by example.

CCMSI is an Affirmative Action/Equal Employment Opportunity employer offering an excellent benefit package included Medical, Dental, Vision, Prescription Drug, Flexible Spending, Life, ESOP and 401K

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