Workers' Compensation Claim Adjuster, Sr. (CA Claims - 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. The Senior Workers’ Compensation Claim Specialist is responsible for managing the investigation and resolution of assigned workers’ compensation claims. This role serves as an advanced development opportunity for individuals being considered for future supervisory or management positions. The Senior Specialist is also responsible for ensuring the delivery of high-quality claims services that meet CCMSI’s corporate standards and align with client expectations. Please note: This is not an HR, administrative, consulting, or advisory support role. This is a true adjusting position. Candidates must have proven experience conducting full investigation, evaluation, negotiation, and resolution of workers’ compensation claims, with end-to-end file ownership and decision-making authority. Applicants without direct claims adjusting experience will not be considered.
Requirements
- Strong oral and written communication skills
- 15 years of works' compensation claim adjusting
- Effective analytical and negotiation skills
- Ability to set and achieve performance goals with initiative
- Effective analytical and negotiation skills
- Ability to manage multiple client accounts and competing priorities
- Comprehensive knowledge of lower-level claims role responsibilities
- Experience adjusting lost-time claims and managing litigated files
- Detail-oriented, self-motivated, and highly organized
- Ability to coordinate, prioritize, and work with minimal supervision
- Flexible, accurate, and proactive approach to work
- Commitment to discretion and confidentiality
- Reliable and predictable attendance during client service hours
- Responsive to internal and external client needs
- Ability to communicate clearly and professionally in verbal and written formats
- Proficiency in Microsoft Office (Word, Excel, Outlook)
- California jurisdiction experience required.
Nice To Haves
- Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required
- California SIP certification
- Claim review presentation experience.
- AIC, ARM, or CPCU designation.
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.
- 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.
Benefits
- 4 weeks PTO + 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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
