Remote Workers' Compensation Claim Adjuster – California Claims Specialist

CCMSI • Irvine, CA, US • 1d ago

Overview

The Workers' Compensation Claim Consultant, Senior at CCMSI offers a fully remote role, Monday through Friday, from 8:00 am to 4:30 pm, dedicated to handling California workers' compensation claims for a single client. This position requires a detail-oriented professional who can manage complex cases, administer benefits, and oversee claim reviews, including handling litigated claims. As part of our Employee-Owned Company, you'll join a team committed to exceptional service, innovation, and continuous growth in self-insurance.

What You Can Expect at CCMSI:

Culture: We are guided by our Core Values, ensuring a supportive environment that values integrity, passion, and enthusiasm.
Career Development: Enjoy robust training programs and opportunities for advancement.
Comprehensive Benefits: In addition to 4 weeks of paid time off, 10 paid holidays, and a range of health, disability, and retirement benefits, we offer an Employee Stock Ownership Plan (ESOP).
Work Environment: With manageable caseloads and resources at your disposal, CCMSI strives to create an enjoyable and supportive work atmosphere.

About the Role:As a Workers' Compensation Claim Consultant, Senior, you will investigate and adjust claims with a commitment to quality, delivering outstanding service that meets both CCMSI's standards and the expectations of our valued clients.

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.
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.

Education and/or Experience

8+ years claim experience.

Computer Skills

Proficient using Microsoft Office.

Certificates, Licenses, Registrations

Adjuster's Certificate is preferred but not required.

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.

#CCMSIIrvine #CCMSICareers #RemoteWork #WorkersCompensation #ClaimsConsultant #HiringNow #CaliforniaClaims #InsuranceCareers #JoinCCMSI #CareerGrowth #EmployeeOwned #GreatPlaceToWork #IND123

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