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 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
