Senior California Workers’ Compensation – Complex Indemnity

Ccmsi • Irvine, CA

1d • $80,000 - $98,000 • Remote

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 and highly skilled Senior Workers’ Compensation Claim Consultant to manage a complex California claims portfolio, including claims involving traveling and multi‑location employees with stipend and per diem wage structures. This role requires advanced professional judgment, strong regulatory knowledge, and the ability to independently manage wage calculations, claim strategy, and dispute resolution. With 5+ years of hands‑on California workers’ compensation claims experience , you will lead thorough investigations, guide complex claim strategies, and ensure fair, timely, and compliant resolutions. This role is designed for a seasoned adjuster who thrives in gray areas, particularly around California wage determination and Average Weekly Wage (AWW) calculations, and who can confidently defend those determinations when challenged.

As a Claim Consultant, you will play a key role in delivering exceptional service to CCMSI clients while upholding our high standards of quality, accuracy, and responsiveness. This role also offers a strong development pathway into more senior claim positions. This is a full life‑cycle WC adjuster position within a TPA environment, and only candidates with proven Workers’ Compensation claims experience will be considered.

Requirements

• Five (5) or more years of California Workers’ Compensation claims experience , managing full life‑cycle claims.
• Demonstrated experience handling complex indemnity claims with minimal supervision.
• Hands‑on experience calculating California AWW , including claims involving stipends, per diem, or other non-traditional wage components .
• Strong understanding of California Labor Code and WC regulations related to wage determination and benefit calculations.
• Ability to independently evaluate and defend wage determinations when disputed.
• Proficiency with Microsoft Office products, including Word, Excel, and Outlook.
• Adjuster license as required by jurisdiction; California SIP preferred or ability to obtain within the first year of employment .

Nice To Haves

• Experience handling claims involving traveling or multi‑location employees.
• Prior experience in a TPA environment.
• Bachelor’s degree preferred but not required.
• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, and vendors.

Responsibilities

• Investigate, evaluate, and adjust Workers’ Compensation claims in accordance with established claim handling standards and California law.
• Independently manage complex indemnity claims , including those involving traveling employees and variable wage structures .
• Calculate and document Average Weekly Wage (AWW) in accordance with California Labor Code, including analysis of stipends, per diem, and living allowances.
• Establish reserves and/or provide reserve recommendations within established 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 disputed bills as needed.
• Authorize and issue claim payments in accordance with claim procedures, industry standards, and established payment authority.
• Negotiate settlements within Corporate Claim Standards, client‑specific handling instructions, and applicable state laws.
• Assist in the selection, referral, and supervision of outside vendors (e.g., legal counsel, surveillance, case management).
• Assess and monitor subrogation claims for resolution.
• Review and maintain an accurate personal diary in the claim system.
• Prepare claim status reports, payment summaries, and reserve reports as requested.
• Compute and adjust disability rates in compliance with California regulations.
• Maintain effective, timely communication with clients, claimants, employers, attorneys, and vendors throughout the claim lifecycle.
• Attend and participate in hearings, mediations, WCAB proceedings, and informal legal conferences, as appropriate.
• Conduct claim reviews and/or training sessions for designated clients, as requested.
• Provide notices of qualifying claims to excess and reinsurance carriers.
• Handle more complex and involved claims than lower‑level claim positions with minimal supervision.
• Ensure compliance with Corporate Claim Handling Standards and special client handling instructions.

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
• Number of Employees: 1-10 employees