California Workers' Compensation Insurance Adjuster

Ccmsi•Irvine, CA

2d•Remote

About The Position

CCMSI is seeking an experienced California Workers’ Compensation Claim Consultant to manage a complex portfolio of claims in a full life-cycle adjuster role within a third-party administrator (TPA) environment. The position requires at least five years of hands-on California Workers’ Compensation claims experience, including handling complex indemnity claims independently with minimal supervision. The consultant will conduct investigations, determine claim strategy, and work toward fair and timely resolutions while providing responsive service to clients and supporting injured workers. The role is based in Irvine, California, and is 100% remote. The California SIP license is preferred, or the employee must be able to obtain it within the first year. The posted salary range is $80,000–$98,000, dependent on experience. CCMSI offers internal training and advancement opportunities, including a development pathway toward more senior claim positions. Visa sponsorship is not provided.

Requirements

Five 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 average weekly wage (AWW), including claims involving stipends, per diem, or other non-traditional wage components.
Strong understanding of California Labor Code and Workers’ Compensation 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 license, or ability to obtain it within the first year of employment.

Nice To Haves

California SIP license.
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.

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

Four weeks of paid time off, accruing throughout the year in accordance with company policy.
10 paid holidays in the first year.
Medical insurance.
Dental insurance.
Vision insurance.
Life insurance.
Disability insurance.
401(k) retirement plan.
Employee Stock Ownership Plan (ESOP).
Internal training and advancement opportunities.
Supportive, team-based work environment.
The role may qualify for bonuses or additional forms of pay.