[Hiring] Workers' Compensation Claim Consultant @CCMSI

Role Description

The Workers’ Compensation Claim Consultant is responsible for investigating and managing assigned workers’ compensation claims while delivering high-quality service aligned with company standards and client expectations. This role also serves as a developmental opportunity for advancement into more senior claims positions. 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 manage workers’ compensation claims in compliance with applicable laws and company standards.
• Establish and maintain appropriate claim reserves within authority limits.
• Review and approve medical, legal, and related expenses; resolve disputed invoices as needed.
• Authorize and process claim payments in line with procedures and industry standards.
• Negotiate settlements in accordance with company guidelines, client requirements, and state regulations.
• Coordinate with and oversee external vendors (e.g., legal, medical, surveillance, case management).
• Monitor subrogation opportunities and pursue recovery when applicable.
• Maintain accurate claim documentation and follow-up activities within the claim system.
• Communicate effectively with clients, claimants, and other stakeholders to ensure timely updates and resolution.
• Prepare claim reports, including status updates, payments, and reserve changes.
• Calculate disability rates in accordance with state guidelines.
• Handle complex claims with minimal supervision.
• Participate in hearings, mediations, and other legal proceedings as needed.
• Support client relationships through claim reviews, training sessions, and high-quality service delivery.
• Ensure compliance with corporate claim standards and client-specific handling instructions.

Qualifications

• California SIP or experienced adjuster license.
• Excellent oral and written communication skills internally and externally.
• 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.
• Responsive to internal and external client needs.

Requirements

• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.
• Experience with handling lost time and litigated claims.
• Prior experience handling multiple accounts.
• TPA experience.

Benefits

• 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.