California Worker's Compensation Adjuster (TPA - Remote)

Ccmsi • Irvine, CA

1d • Remote

About The Position

CCMSI is seeking a California Workers’ Compensation Claim Specialist to manage a dedicated portfolio of claims and help injured workers reach fair, timely resolutions. The specialist leads claim investigations, determines compensability, and handles claims in compliance with applicable laws, company standards, and client-specific instructions. The role calls for balancing empathy with sound judgment while delivering high-quality service to clients and claimants. It may also provide an advanced development path toward future supervisory or management roles.

The position is based in Irvine, California, and is performed remotely. The schedule is 8:00 a.m. to 4:30 p.m. Pacific Time. The stated salary range is $85,000–$95,000, depending on experience. Compensation may also include bonuses or other forms of pay.

Requirements

• At least 10 years of California Workers’ Compensation claims-handling experience, including full claim investigation, evaluation, and resolution.
• A Workers’ Compensation designation is required: CAWCS, WCIRB, CPWC, or WCCA.
• Responsiveness to internal and external client needs.
• Strong analytical and negotiation abilities.
• Strong internal and external communication skills.
• Proven experience handling complex and litigated California claims.
• Knowledge of the responsibilities of lower-level claim positions.

Nice To Haves

• Bilingual Spanish proficiency is highly valued but not required.
• SIP designation is preferred but not required.
• Bachelor’s degree is preferred but not required.

Responsibilities

• Investigate, evaluate, and adjust claims in accordance with established claim-handling standards and laws.
• Establish reserves or provide reserve recommendations within established authority levels.
• Review, approve, or oversee medical, legal, damage-estimate, and miscellaneous invoices to determine whether they are reasonable and related to the claim.
• Negotiate disputed bills or invoices for resolution.
• Authorize and make claim payments according to claim procedures, industry standards, and established payment authority.
• Negotiate settlements in accordance with corporate claim standards, client-specific instructions, and state laws when appropriate.
• Assist in selecting, referring, and supervising claim files sent to outside vendors, such as legal, surveillance, and case-management providers.
• Review and maintain a personal diary in the claim system.
• Assess and monitor subrogation claims through resolution.
• Compute disability rates in accordance with state laws.
• Coordinate timely and effective communication with clients, claimants, and other appropriate parties throughout the claim adjustment process.
• Provide notices of qualifying claims to excess or reinsurance carriers.
• Comply with corporate claim-handling standards and special client instructions.

Benefits

• Four weeks of paid time off, accruing throughout the year in accordance with company policy.
• Ten 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.

What This Job Offers

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