[Hiring] Workers' Compensation Claim Consultant @Ccmsi

Role Description

We are seeking an experienced and highly skilled Workers’ Compensation Claim Consultant to manage a dedicated client portfolio of complex California workers’ compensation claims with confidence, empathy, and sound professional judgment. With 5+ years of hands-on claims experience, you will lead thorough investigations, develop and execute claim strategies, and ensure fair, timely resolutions. The ideal candidate will possess an active California Workers’ Compensation Adjuster License and demonstrated experience handling litigated claims from inception through resolution. This role also offers a strong development pathway for advancement into more senior claim positions. You will play a key role in delivering exceptional service to CCMSI clients, fostering strong client relationships, and upholding our high standards of quality, responsiveness, and claims excellence.

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 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.

Qualifications

• 5+ years of California Workers’ Compensation claims experience.
• Proficiency with Microsoft Office products, including Word, Excel, and Outlook.
• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.
• California Adjuster's license is required.

Requirements

• Bachelor’s degree is preferred but not required.
• 2+ Experience handling high complexity workloads.

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.