JOB DETAILS

California Workers' Compensation Claims Adjuster - Remote

Overview

At CCMSI, we strive to attract the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we prioritize developing our staff through structured career development programs, rewarding and recognizing individual and team efforts. Certified as a Great Place To Work, our employee satisfaction and retention rank in the 95th percentile.

Reasons you should consider a career with CCMSI:

Culture: Our Core Values are embedded in our culture, guiding how we treat our employees as valued partners—with integrity, passion, and enthusiasm.
Career Development: CCMSI offers robust internships and internal training programs for advancement within our organization, ensuring continuous growth and career progression.
Benefits: Our comprehensive benefits package includes 4 weeks of paid time off in your first year, plus 10 paid holidays. We also offer Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP.
Work Environment: We provide an environment where employees enjoy coming to work every day, are equipped with the necessary resources to perform their job, and manage manageable caseloads.

Position Overview:

Workers' Compensation Claim Consultant, Senior

As a Workers' Compensation Claim Consultant, Senior, you will be responsible for the investigation and adjustment of assigned claims. You will be accountable for the quality of claim services as perceived by CCMSI clients and will work within our corporate claim standards.

Key Details:

Location: Remote
Schedule: Monday to Friday
Types of Accounts: Light Industrial, Trucking, other Miscellaneous
Jurisdiction: California
License Required: California Adjuster's License
Preferred Certifications: SIP preferred; WCCA/WCCP/AIC optional

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.
Prepare reports detailing claim status, payments and reserves, as requested.
Provide notices of qualifying claims to excess/reinsurance carriers.
Conduct claim reviews and/or training sessions for clients, as requested.
Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.
Administer benefits on claims
Ensure timely utilization review (UR) processing
Process bills promptly
Communicate effectively with injured workers, clients, and attorneys
Maintain proper documentation of the claim file
Provide summary updates every 30, 60, or 90 days
Drive claims to resolution
Performs other duties as assigned.

Qualifications

Excellent oral and written communication skills.
Initiative to set and achieve performance goals.
Good analytic and negotiation skills.
Ability to cope with job pressures in a constantly changing environment.
Knowledge of all lower level claim position responsibilities.
Must be detail oriented and a self-starter with strong organizational abilities.
Ability to coordinate and prioritize required.
Flexibility, accuracy, initiative and the ability to work with minimum supervision.
Discretion and confidentiality required.
Reliable, predictable attendance within client service hours for the performance of this position.
Responsive to internal and external client needs.
Ability to clearly communicate verbally and/or in writing both internally and externally.

Performance Metrics:

Timely payment of benefits with no self-imposed penalties
Keeping diaries and mail up to date
Appropriately reserving files for the most probable outcome

Education and/or Experience

3-5 years of experience as a claims examiner handling semi-complex to complex-level claims
Strong analytical and problem-solving skills
Excellent communication and negotiation abilities
Ability to work independently and manage multiple priorities

Computer Skills

Proficient using Microsoft Office.

License Required: California Adjuster's License

Preferred Certifications: SIP preferred; WCCA/WCCP/AIC optional

CORE VALUES & PRINCIPLES

Responsible for upholding the CCMSI Core Values & Principles which include: performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity; insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better; and leading by example.

CCMSI is an Affirmative Action/Equal Employment Opportunity employer offering an excellent benefit package included Medical, Dental, Vision, Prescription Drug, Flexible Spending, Life, ESOP and 401K.

#CCMSICareers #CCMSIIrvine #ESOP #JobOpportunity #NowHiring #CaliforniaJobs

#RemoteWork #WorkersCompensation #ClaimsConsultant #InsuranceJobs #CareerGrowth #EmployeeOwned #JoinOurTeam #GreatPlaceToWork #CAJobs #WorkFromHome #CareerDevelopment #JobOpening #IND123

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