Remote Workers' Compensation Adjuster – 5+ Years CA Experience Required - CCMSI

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!

• 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.

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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