California Worker's Compensation Adjuster (TPA - Remote)

CCMSI; Irvine (CA); Remote; USD 85.000 - 95.000; Vollzeit

Benefits dieser Stelle

PTO 4 weeks

Holiday pay

Health benefits (Medical, Dental, VIsn

401(k) + ESOP

Career growth

Team culture

Zusammenfassung

CCMSI in Irvine, CA is seeking a California Workers’ Compensation Claim Specialist to own a portfolio of claims, conduct investigations, determine compensability, and guide cases to timely resolution.

This role offers remote reporting, a schedule of 8:00 am - 4:30 pm PST, and a path toward supervisory opportunities, with a competitive salary and comprehensive benefits.

Qualifikationen

• 10+ years of California Workers’ Compensation claims handling experience.
• Designation in CAWCS, WCIRB, CPWC, or WCCA is required.
• Strong communication and negotiation abilities.

Aufgaben

• Investigate, evaluate and adjust claims per standards and laws.
• Establish reserves and provide reserve recommendations.
• Review and approve medical, legal, and other invoices; negotiate disputed bills.
• Authorize and make payments within authority.
• Negotiate settlements per standards and state laws.
• Coordinate with outside vendors as needed.
• Maintain diary on claim system and monitor subrogation.

Kenntnisse

Investigation

Negotiation

Communication

Analytical thinking

Ausbildung

Bachelor's degree

Jobbeschreibung

Overview

Workers' Compensation Claim Specialist

Location

Irvine, CA * reporting remotely*

Schedule

8:00 am - 4:30pm (PST)

Salary Range

$85,000 - $95,000 depending on experience

Build Your Career With Purpose at CCMSI

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.

Job Summary

We are seeking a driven and compassionate California 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—leading investigations, determining compensability, and guiding each case toward a fair and timely resolution.

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.

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.

Qualifications

Required

• 10+ years of California Workers’ Compensation claims handling experience, including full claim investigation, evaluation, and resolution.
• Worker's Compensation Designation is required (CAWCS, WCIRB, CPWC, WCCA)
• Responsiveness to internal and external client needs.
• Strong analytical and negotiation abilities.
• Strong internal and external communication
• Proven experience handing complex and litigated California claims
• Knowledge of all lower‑level claim position responsibilities.

Nice To Have

• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.
• SIP is preferred, but not required
• Bachelor's degree is preferred but not required

Why You’ll Love Working Here

• 4 weeks (Paid time off that accrues throughout the year in accordance with company policy) + 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

How We Measure Success

• Quality claim handling – thorough investigations, strong documentation, well-supported decisions
• Compliance & audit performance – adherence to jurisdictional and client standards
• Timeliness & accuracy – purposeful file movement and dependable execution
• Client partnership – proactive communication and strong follow-throughProfessional judgment – owning outcomes and solving problems with integrity
• Cultural alignment – believing every claim represents a real person and acting accordingly

Compensation & Compliance

The posted salary reflects CCMSI’s good‑faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.

CCMSI offers comprehensive benefits including medical, dental, vision, life, and disability insurance. Paid time off accrues throughout the year in accordance with company policy, with paid holidays and eligibility for retirement programs in accordance with plan documents.

Visa Sponsorship

CCMSI does not provide visa sponsorship for this position.

ADA Accommodations

CCMSI is committed to providing reasonable accommodations throughout the application and hiring process.

Equal Opportunity Employer

CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations.

Background checks, if required for the role, are conducted only after a conditional offer and in accordance with applicable fair chance hiring laws.

Our Core Values

• Lead with transparency We build trust by being open and listening intently in every interaction.
• Perform with integrity We choose the right path, even when it is hard.
• Chase excellence We set the bar high and measure our success. What gets measured gets done.
• Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own.
• Win together Our greatest victories come when our clients succeed.

We don’t just work together—we grow together. If that sounds like your kind of workplace, we’d love to meet you.

#EmployeeOwned #GreatPlaceToWorkCertified #CCMSICareers #ESOP #IND123