[Hiring] Workers' Compensation Claim Consultant @CCMSI

Role Description

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.

Qualifications

• 5+ years of California Workers’ Compensation claims experience.
• Proficiency with Microsoft Office products, including Word, Excel, and Outlook.
• SIP is required, or you must be able to obtain.
• Experience handling a mostly litigated workload.

Preferred Qualifications

• Bachelor’s degree is preferred but not required.
• Bilingual (Spanish) proficiency—highly valued for communicating with claimants, employers, or vendors, but not required.

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.

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.

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, 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.