California Work Comp Insurance Adjuster

Ccmsi • Las Vegas, NV

6d • Remote

About The Position

CCMSI is seeking a Workers' Compensation Claim Specialist to manage a dedicated portfolio of claims for a single PEO account. The role involves investigating claims, determining compensability, and guiding cases toward fair and timely resolution. The dedicated-account structure enables the specialist to build client relationships, develop knowledge of the client's operations, and serve as a trusted claims partner. The position can also provide an advanced development path toward future supervisory or management roles.

The specialist delivers claims services in accordance with established handling standards, applicable laws, and client-specific instructions. Success is measured by claim quality, compliance, timeliness and accuracy, client partnership, professional judgment, and cultural alignment. The position is based in Irvine, California, with remote reporting, and requires travel once per year. The posted salary range is $88,000–$92,000, depending on experience; the role may also qualify for bonuses or other forms of pay.

Requirements

• At least 5 years of California Workers’ Compensation claims handling experience, including full claim investigation, evaluation, and resolution.
• SIP and California adjuster licenses are required.
• Experience handling litigated and lost-time claims.
• Must be able to travel once a year.
• 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; valued for communicating with claimants, employers, or vendors, but not required.
• Experience handling fast food claims.
• Bachelor's degree; preferred but not required.
• Professional designations such as AIC, ARM, or CPCU; 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 notify excess or reinsurance carriers of qualifying claims when appropriate.
• Review, approve, and oversee medical, legal, damage estimate, invoice, and other external vendor services for reasonableness, necessity, and claim relatedness.
• Negotiate disputed bills and supervise referrals to outside vendors.
• Authorize and issue claim payments in accordance with 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 in 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 claim handling standards and client-specific instructions.

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.

What This Job Offers

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