California Workers' Compensation Insurance Adjuster

CCMSI; Irvine (CA); Remote; USD 80,000 - 98,000; Full time

Benefits offered by this job

4 weeks paid time off

10 paid holidays

Medical, Dental, Vision, Life, and Dis

401(k) and ESOP

Job summary

CCMSI in California seeks a Senior Workers’ Compensation Claim Consultant to manage a complex portfolio with confidence and sound judgment. With 5+ years of hands-on claims experience, you will lead investigations, guide strategy, and deliver timely resolutions in a remote setting.

This role offers a strong development path into more senior positions and emphasizes quality, compliance, and client service across a national client base.

Qualifications

• Five (5) or more years of California Workers’ Compensation claims experience, managing full life-cycle claims.
• Demonstrated experience handling complex indemnity claims with minimal supervision.
• Hands-on experience calculating California AWW, including stipends or non-traditional wage components.
• Strong understanding of California Labor Code and WC regulations related to wage determination and benefits.
• Ability to independently evaluate and defend wage determinations when disputed.

Responsibilities

• Investigate, evaluate, and adjust claims in compliance with company standards and laws.
• Establish and manage reserves within authority guidelines.
• Review, approve, and negotiate medical, legal, and related claim expenses.
• Authorize claim payments and negotiate settlements within guidelines.
• Coordinate external vendors and monitor claim progression and reporting.

Skills

California WC claims

Claim investigation

Negotiation

Reserving

MS Office

Education

Bachelor's degree preferred

Tools

Microsoft Office

Job description

Overview

Workers’ Compensation Claim Consultant – Senior (California)

Location: Irvine, CA (100% remote)

Salary Range: $80,000 – $98,000 (dependent on experience)

License Requirement: California SIP preferred or ability to obtain within first year of employment

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 an experienced and highly skilled California Workers’ Compensation Claim Consultant to manage a complex portfolio of claims with confidence, empathy, and sound professional judgment. With 5+ years of hands‑on claims experience, you will lead thorough investigations, guide claim strategy, and ensure fair, timely resolutions. This role also offers a strong development pathway for advancement into more senior claim positions. As a Claim Consultant, you will play a key role in delivering exceptional service to CCMSI clients and upholding our high standards of quality and responsiveness.

This is a full life‑cycle WC adjuster position within a TPA environment, and only candidates with proven Workers’ Compensation claims experience will be considered.

Responsibilities

• Investigate, evaluate, and adjust claims in compliance with company standards and applicable laws.
• Establish and manage reserves within authority guidelines.
• Review, approve, and negotiate medical, legal, damage estimate, and related claim expenses.
• Authorize claim payments and negotiate settlements within established authority and client-specific guidelines.
• Coordinate and oversee external vendors, including legal counsel, surveillance, and case management providers.
• Monitor claim progression, including subrogation opportunities, diary management, and reporting requirements.
• Maintain timely communication with clients, claimants, and other stakeholders throughout the claim lifecycle.
• Provide claim status updates, reserve analyses, and other reports as requested.
• Calculate disability rates and ensure compliance with applicable state regulations.
• Notify excess and reinsurance carriers of qualifying claims.
• Handle complex claims independently with minimal supervision.
• Participate in hearings, mediations, legal conferences, client meetings, training sessions, and claim reviews, as appropriate.
• Support client satisfaction through responsive service and adherence to corporate claim handling standards and client instructions.
• Contribute to special projects, training materials, newsletters, and other departmental initiatives as requested.

Required Qualifications

• Five (5) or more years of California Workers’ Compensation claims experience, managing full life‑cycle claims.
• Demonstrated experience handling complex indemnity claims with minimal supervision.
• Hands‑on experience calculating California AWW, including claims involving stipends, per diem, or other non‑traditional wage components.
• Strong understanding of California Labor Code and WC regulations related to wage determination and benefit calculations.
• Ability to independently evaluate and defend wage determinations when disputed.
• Proficiency with Microsoft Office products, including Word, Excel, and Outlook.
• Adjuster license as required by jurisdiction; California SIP preferred or ability to obtain within the first year of employment.

Preferred Qualifications

• Experience handling claims involving traveling or multi‑location employees.
• Prior experience in a TPA environment.
• Bachelor’s degree preferred but not required.
• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, and vendors.

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-through
• Professional 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

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.

Additional Information

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

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