Workers' Compensation Claim Specialist

Ccmsi • Concord, CA

2d • 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 for a single fast-food client account, leading investigations, determining compensability, and guiding each case toward fair and timely resolution. This dedicated-account structure allows you to develop strong client relationships, gain in-depth knowledge of the client's operations, and become a trusted claims partner. 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 California Workers’ Compensation claims handling experience, including full claim investigation, evaluation, and resolution.
• Must be able to travel one time a year.
• SIP and CA adjusters license is required.
• Experience handling litigated and lost time claims.
• Responsiveness to internal and external client needs.
• Strong analytical and negotiation abilities.
• Knowledge of all lower‑level claim position responsibilities.

Nice To Haves

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

Responsibilities

• Investigate, evaluate and adjust claims in accordance with established claim handling standards and applicable laws.
• Establish reserves within assigned authority levels and provide notice of qualifying claims to excess or reinsurance carriers when appropriate.
• Review, approve and oversee medical, legal, damage estimates, invoices and other external vendor services to ensure they are reasonable, necessary and related to designated claims.
• Negotiate disputed bills and supervise referrals to outside vendors.
• Authorize and issue claim payments in accordance with claim procedures, industry standards and established authority levels.
• Negotiate settlements in accordance with Corporate Claim Standards, client-specific handling instructions and applicable laws.
• Review and maintain claim diaries within the claim management system.
• Assess and monitor subrogation opportunities through resolution.
• Compute disability rates in accordance with applicable state laws.
• Maintain effective and timely communication with clients, claimants and other stakeholders while ensuring compliance with Corporate Claim Handling Standards and client-specific handling instructions.

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)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree