Overview
Workers' Compensation Claim Consultant (Remote) – California Jurisdiction
At CCMSI, we seek the best and brightest to join our team of professionals. As a leading Third Party Administrator specializing in self-insurance services, we’re committed to delivering exceptional service to our clients. We are proud to be an Employee-Owned Company, dedicated to developing our staff through structured career programs and rewarding individual and team efforts. Certified as a Great Place to Work, our employee satisfaction and retention ranks in the 95th percentile.
Position Overview: We are currently seeking an experienced Workers' Compensation Claim Consultant to handle claims in the state of California. This is a fully remote position, with flexible hours of either 7:00 am to 3:30 pm or 8:00 am to 4:30 pm, Monday through Friday.
Key Requirements:
- 5+ years of California Workers' Compensation claim handling experience is required.
- Must hold a Self-Insurance Plan (SIP) Certificate or California Adjuster Certificate.
- Comprehensive knowledge of California Workers' Compensation laws and regulations.
- Strong investigative, analytical, and negotiation skills.
- Experience in maintaining compliance with statutory requirements and company claim handling standards.
- Ability to manage a caseload efficiently while meeting deadlines and maintaining claim quality.
Primary Responsibilities:
- Investigate and adjust assigned Workers' Compensation claims in compliance with California laws.
- Accurately assess liability and determine appropriate claim resolutions.
- Communicate effectively with claimants, clients, medical providers, and legal professionals.
- Maintain detailed claim documentation and ensure timely reporting.
- Handle claims with a customer-focused approach, upholding the quality of services provided to CCMSI clients.
Why Choose a Career at CCMSI?
- Culture: Our core values emphasize integrity, passion, and a positive work environment.
- Career Development: CCMSI offers structured training programs and opportunities for growth within the company.
- Competitive Benefits: Enjoy 4 weeks of paid time off in your first year, 10 paid holidays, Medical, Dental, Vision, Life Insurance, Critical Illness coverage, Short and Long-Term Disability, 401K, and Employee Stock Ownership Plan (ESOP).
- Work Environment: We provide resources for success and ensure that claims staff are assigned manageable caseloads to promote work-life balance.
Take the next step in your career with CCMSI, where your expertise is valued, and your contributions make an impact. Apply today!
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.)
- Assess and monitor subrogation claims for resolution.
- Review and maintain personal diary on claim system.
- Client satisfaction.
- Prepare reports detailing claim status, payments and reserves, as requested.
- Compute disability rates in accordance with state laws.
- Effective and timely coordination of communication with clients, claimants and appropriate parties throughout the claim adjustment process.
- Prepare newsletter articles, as requested.
- Provide notices of qualifying claims to excess/reinsurance carriers.
- Handle more complex and involved claims than lower level claim positions with minimum supervision.
- Conduct claim reviews and/or training sessions for designated clients, as requested.
- Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.
- Compliance with Corporate Claim Handling Standards and special client handling instructions as established.
- Performs other duties as assigned.
Qualifications
Education and/or Experience
Five or more years claims experience is required.
Computer Skills
Proficient using MicroSoft Office products such as Word, Excel, Outlook, etc.
Certificates, Licenses, Registrations
Must hold a Self-Insurance Plan (SIP) Certificate or California Adjuster Certificate.
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.
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