Workers' Compensation Claim Specialist

Ccmsi • Irvine, CA

1d • Remote

About The Position

We are seeking a driven and compassionate Workers’ Compensation Claim Specialist to join our team and make a meaningful impact in the lives of injured workers. In this role, you will take ownership of a dedicated portfolio of claims—leading investigations, determining compensability, and guiding each case toward a fair and timely resolution. This position offers the opportunity to grow your technical expertise and can serve as an advanced development path for future supervisory or management roles. As a Claim Specialist, you play a vital role in delivering the high‑quality service our clients count on and upholding CCMSI’s commitment to excellence.

Requirements

• 5+ years of Workers’ Compensation claims handling experience, including full claim investigation, evaluation, and resolution.
• Responsiveness to internal and external client needs.
• Strong analytical and negotiation abilities.
• Knowledge of all lower‑level claim position responsibilities.
• Adjuster’s license may be required based on jurisdiction.

Nice To Haves

• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.
• Bachelor's degree is preferred but not required
• Professional designations such as AIC, ARM, or CPCU are preferred but not required

Responsibilities

• Manage workers' compensation claims from investigation through resolution in compliance with company standards and applicable laws.
• Evaluate claim exposure and establish appropriate reserves within authority guidelines.
• Review and approve medical, legal, and other claim-related expenses to ensure accuracy and cost effectiveness.
• Issue claim payments and negotiate settlements in accordance with company, client, and state requirements.
• Coordinate with attorneys, medical providers, case managers, and other vendors to support effective claim outcomes.
• Monitor claim activity, maintain accurate file documentation, and manage diary schedules.
• Identify and pursue subrogation opportunities and excess/reinsurance reporting requirements.
• Calculate disability benefits and ensure timely, accurate claim administration.
• Maintain proactive communication with clients, claimants, and other stakeholders throughout the claim lifecycle.
• Adhere to corporate claim handling standards and client-specific service 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
• Education Level: Associate degree