Workers’ Compensation Insurance Adjuster

Ccmsi • Irvine, CA

2d • Remote

About The Position

We are seeking a driven and compassionate Workers’ Compensation Insurance Adjuster 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 moderate‑complexity claims within a single account, leading investigations, determining compensability, and guiding each case toward a fair and timely resolution. Approximately 85% of the claims in this role are litigated, requiring strong critical thinking, negotiation, and litigation management skills. This position offers the opportunity to grow your technical expertise and serves 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

• 2-3 years of California Workers’ Compensation claims handling experience , including full claim investigation, evaluation, and resolution.
• Responsiveness to internal and external client needs.
• Excellent time management skills
• Experience handling litigated claims
• Strong analytical and negotiation abilities.
• Must be able to handle a claims from inception through resolution.
• SIP is required or must be able to obtain.

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

• Investigate, evaluate and adjust claims in accordance with established claim handling standards and laws.
• Establish reserves and/or provide reserve recommendations within established reserve authority levels.
• Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated claims.
• Negotiate any disputed bills or invoices for resolution.
• Authorize and make payments of claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.
• Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate.
• Assist in the selection, referral and supervision of designated claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.)
• Review and maintain personal diary on claim system.
• Assess and monitor subrogation claims for resolution.
• Compute disability rates in accordance with state laws.
• Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the claim adjustment process.
• Provide notices of qualifying claims to excess/reinsurance carriers.
• Compliance with Corporate Claim Handling Standards and special client handling instructions as established.

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