Primary Responsibility

The Adjuster will manage an assigned caseload of medical only and lost time Workers’ Compensation claims from the first report of injury to resolution according to the applicable law. This includes making decisions about liability/compensability, evaluating losses, and negotiating settlements. The role interacts with claimants, clients, attorneys, and other third parties throughout the claims management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers.

Essential Functions & Responsibilities

• Manage assigned caseload of workers’ compensation claims.
• Make decisions about compensability, set reserves and negotiate settlements.
• Assigns, when necessary, appropriate vocational rehabilitation for the purposes of a labor market survey.
• Coordinates, when necessary, light duty accommodation with AAFES’ Human Resources Center.
• Determines whether an injured worker is a Medicare beneficiary or possibly receiving SSDI benefits and assigns, when necessary, a Medicare SetAside to CCS Medicare Services.
• Interact with claimants, clients, attorneys, representatives of the U.S. Department of Labor, medical providers and other thirdparty representatives throughout the claims process.
• Assess worst probable exposure and apply appropriate reserving practices.
• Timely initial contacts and investigation of new claims.
• Prepares reports and other analytical data as requested by the management team.
• Independently identify and resolve most common claim file issues.
• Prepare for and/or represent the Employer at Informal Conferences.
• Adjust extent of disability claims to include Labor Market Surveys and Loss of WageEarning Capacity (LWEC) calculations.
• Accurately calculate present value of LWEC claims and prepare settlement memos/analysis.
• Negotiate settlements.
• Adjust claims requiring Medicare SetAside Arrangements (MSAs).
• Adjust claims involving S33 subrogation.
• Adjust claims involving S8(f).
• Verify coverage.
• Take recorded statements as needed.
• Document files as necessary on conversation and actions taken.
• Identify and address subrogation issues.
• Administer benefits timely and accurately.
• Complete jurisdictional forms timely and accurately.
• Monitor ongoing medical treatment.
• Request second medical opinions as needed.
• Request surveillance appropriately.
• Work mail and diary on a daily basis.

Additional Functions & Responsibilities

• Client visits as required.
• Preparation of documents for informal conferences and formal hearings; participate in the
• proceedings at client discretion.
• Communicates directly with the client.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Required Qualifications

• Must have at least 23 years of experience handling indemnity workers’ compensation claims for DBA.
• High school diploma.
• Ability to follow instructions, procedures, and rules.
• Must have strong attention to detail.
• Must have good written and oral communication skills.
• Must be well organized and the ability to multitask.
• Basic computer skills in MS Word, Excel and Outlook.
• Fast, accurate data entry

Preferred Qualifications

• College degree in business or other related discipline.

Knowledge, Skills & Abilities

• Proficient in MS Office.
• Consistently completes timely investigation depending on claim type and makes timely compensability determinations.
• Consistently makes timely and accurate LS form filings as well as Indemnity/Medical payments.
• Consistently reviews and establishes appropriate reserves and documents rationale.
• Demonstrates the ability to consistently and concisely document Vista claim notes with pertinent information, to include a plan of action.
• Demonstrates good time management skills, to include timely completion of claim file diaries, Image Right tasks and organization.
• Consistently adheres to all Company and account specific policies and procedures.
• Consistently ensures all claim file coding is accurate/current.
• Ability to communicate effectively, in both oral and written forms of communication.
• Ability to work in a fastpaced environment.
• High level of accuracy and attention to detail.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to calculate benefits in accordance with applicable law

Travel

• Less than 5% travel

About Contract Claims Services, Inc.

Contract Claims Services, Inc. (CCSI) provides professional claims handling and adjusting services for insurance carriers, self-insured groups, and managing general agencies across a variety of industries. Our team delivers efficient, fair, and timely claims resolutions that reflect our commitment to quality service and trusted partnerships. As a subsidiary of Heartland Security Insurance Group, CCSI combines the expertise and responsiveness of a specialized adjusting firm with the stability and resources of a larger organization. This allows us to deliver customized solutions while maintaining the personal attention our clients value most. At CCSI, we pride ourselves on our integrity, professionalism, and dedication to doing what’s right—for our clients and the people they serve. Our culture is built on teamwork, accountability, and continuous improvement, ensuring every employee has the opportunity to grow and make an impact.