Workers Compensation Claim Specialist (CA Expertise Required - Mid to Senior Adjuster)
About The Position
At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success. We don't just process claims—we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work® , and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day. We are seeking a Workers' Compensation Claim Consultant to manage complex California workers' compensation claims from intake through resolution for a PEO/Staffing account . This role may be remote or hybrid , reporting to our Irvine, CA branch . This position is designed for an experienced California adjuster who brings strong judgment, deep regulatory knowledge, and the ability to independently manage high-exposure and complex claims with minimal supervision. As a consultant, you'll serve as a trusted partner to clients, mentor to peers, and subject-matter resource within the team.
Requirements
- 5+ years of California workers' compensation claims experience , including cradle-to-grave handling
- Demonstrated success managing complex or high-exposure claims with minimal supervision
- Strong working knowledge of California WC laws, benefits, disability calculations, and litigation processes
- Excellent analytical, negotiation, and decision-making skills
- Strong written and verbal communication skills with the ability to interface confidently with clients
- Ability to manage workload independently while meeting service commitments
Nice To Haves
- SIP designation or ability to obtain within a defined timeframe
- Bachelor's degree
- Experience supporting PEO and/or staffing accounts
- Proficiency with claims systems and Microsoft Word, Excel, and Outlook
- Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.
Responsibilities
- Independently investigate, evaluate, and resolve complex California workers' compensation claims in compliance with applicable laws, CCMSI standards, and client handling instructions
- Establish reserves and provide reserve recommendations within assigned authority levels
- Review, approve, and oversee medical, legal, and miscellaneous invoices to ensure accuracy, reasonableness, and claim-relatedness; negotiate disputed charges
- Authorize and issue claim payments within assigned settlement and payment authority
- Negotiate settlements in accordance with corporate standards, client authorization, and California regulations
- Coordinate with and oversee outside vendors, including defense counsel, surveillance, and case management partners
- Assess and pursue subrogation opportunities
- Maintain accurate diaries, documentation, and claim strategy within the claims system
- Prepare claim status reports, payment summaries, and reserve documentation as requested
- Provide required notice and reporting to excess or reinsurance carriers
- Attend and participate in hearings, mediations, and informal legal conferences, as appropriate
- Communicate effectively and proactively with clients, injured workers, attorneys, and internal partners
- Conduct claim reviews, training sessions, or client presentations as requested
- Ensure consistent compliance with Corporate Claim Handling Standards and client-specific instructions
Benefits
- 4 weeks PTO + 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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
1,001-5,000 employees
