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Role Description

This experienced Workers’ Compensation Claim Adjuster position is responsible for investigating, evaluating, and resolving assigned workers’ compensation claims. This role may also serve as an advanced developmental position for individuals seeking future supervisory or management opportunities. Additionally, the Claim Specialist is accountable for delivering high‑quality claim services that meet CCMSI’s corporate standards and uphold the level of service our clients expect.

• Investigate, evaluate, and adjust workers’ compensation claims in compliance with established standards, procedures, and applicable laws.
• Set claim reserves or provide reserve recommendations within assigned authority levels.
• Review, approve, or oversee medical, legal, damage, and miscellaneous invoices to ensure they are reasonable and related to the claim; negotiate disputed bills when necessary.
• Authorize and process claim payments according to established guidelines, industry standards, and assigned payment authority using the claim payment system.
• Negotiate settlements in accordance with Corporate Claim Standards, client-specific instructions, and state regulations when appropriate.
• Assist in selecting, referring, and supervising outside service providers (e.g., legal counsel, surveillance vendors, case management).
• Maintain an organized and up‑to‑date personal diary within the claim system to track ongoing file activity.
• Assess and pursue subrogation opportunities to ensure timely recovery.
• Calculate disability rates in compliance with state laws and guidelines.
• Provide timely, effective communication with clients, claimants, and other involved parties throughout the claim lifecycle.
• Submit required notices for qualifying claims to excess and reinsurance carriers.
• Adhere to Corporate Claim Handling Standards and follow all special client instructions.

Qualifications

• Minimum of 5 years of workers’ compensation claim adjusting experience.
• Proficiency in Microsoft Office (Word, Excel, Outlook).
• Strong written and verbal communication skills.
• Proven ability to manage deadlines and multiple priorities effectively.
• California jurisdiction experience required.

Requirements

• Bilingual (Spanish) proficiency - highly valued for communication with claimants, employers, or vendors, but not required.
• California SIP certification.
• Claim review presentation experience.
• AIC, ARM, or CPCU designation.

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.