Workers' Compensation Claim Consultant

Ccmsi • Irvine, CA

1d • Remote

About The Position

We are seeking an experienced and highly skilled California Workers’ Compensation Claim Consultant to manage a complex portfolio of claims with confidence, empathy, and sound professional judgment. With 5+ years of hands‑on claims experience, you will lead thorough investigations, guide claim strategy, and ensure fair, timely resolutions. This role also offers a strong development pathway for advancement into more senior claim positions. As a Claim Consultant, you will play a key role in delivering exceptional service to CCMSI clients and upholding our high standards of quality and responsiveness. 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

• 5+ years of California Workers’ Compensation claims experience.
• Proficiency with Microsoft Office products, including Word, Excel, and Outlook.
• SIP is required, or you must be able to obtain.
• Experience handling a mostly litigated workload.

Nice To Haves

• Bachelor’s degree is preferred but not required.
• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.

Responsibilities

• Investigate, evaluate, and adjust claims in compliance with company standards and applicable laws.
• Establish and manage reserves within authority guidelines.
• Review, approve, and negotiate medical, legal, damage estimate, and related claim expenses.
• Authorize claim payments and negotiate settlements within established authority and client-specific guidelines.
• Coordinate and oversee external vendors, including legal counsel, surveillance, and case management providers.
• Monitor claim progression, including subrogation opportunities, diary management, and reporting requirements.
• Maintain timely communication with clients, claimants, and other stakeholders throughout the claim lifecycle.
• Provide claim status updates, reserve analyses, and other reports as requested.
• Calculate disability rates and ensure compliance with applicable state regulations.
• Notify excess and reinsurance carriers of qualifying claims.
• Handle complex claims independently with minimal supervision.
• Participate in hearings, mediations, legal conferences, client meetings, training sessions, and claim reviews, as appropriate.
• Support client satisfaction through responsive service and adherence to corporate claim handling standards and client instructions.
• Contribute to special projects, training materials, newsletters, and other departmental initiatives as requested.

Benefits

• 4 weeks (Paid time off that accrues throughout the year in accordance with company policy)
• 10 paid holidays in your first year
• Medical, Dental, Vision, Life, and Disability Insurance
• 401(k) and Employee Stock Ownership Plan (ESOP)
• Internal training and advancement opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed