Workers' Compensation Claim Specialist

Overview

Workers' Compensation Claim Specialist
Location: Irvine, CA (reporting remotely)
Schedule: 8:00am - 4:30 pm
Salary Range: $85,000 - $95,000 (depending on experience)
Build Your Career With Purpose at CCMSI

At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success.

We don't just process claims-we support people. As the largest privately owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work®, and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day.
Job Summary

The Workers' Compensation Claim Specialist is responsible for managing a caseload consisting primarily of litigated and some complex claims, ensuring timely and accurate payment of benefits while delivering high-quality service to our clients. This role involves conducting investigations, determining compensability, managing medical treatment through maximum medical improvement (MMI), and maintaining appropriate reserves throughout the life of the claim.

The Claim Specialist works closely with clients, defense counsel, and medical providers to evaluate claims for settlement, negotiate resolutions, and bring cases through settlement and closure. This position offers an opportunity to build advanced technical expertise and serves as a developmental path toward future supervisory or management roles.

Responsibilities

When we hire Workers' Compensation Adjusters at CCMSI, we look for detail-driven problem-solvers who balance empathy with sound judgment, navigate complex regulations with confidence, and deliver fair, timely outcomes that support injured workers and strengthen client trust.

• 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.)
• Review and maintain personal diary on claim system.
• Assess and monitor subrogation claims for resolution.
• Compute disability rates in accordance with state laws.
• Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the claim adjustment process.
• Provide notices of qualifying claims to excess/reinsurance carriers.
• Compliance with Corporate Claim Handling Standards and special client handling instructions as established.

Qualifications

Required:

• 10+ years of Workers' Compensation claims handling experience , including full claim investigation, evaluation, and resolution.
• Proof of current CEU credits
• Responsiveness to internal and external client needs.
• Strong analytical and negotiation abilities.
• Knowledge of all lower-level claim position responsibilities.
• Experience handling litigated and complex claims

Nice to Have:

• Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, or vendors, but not required.
• SIP is preferred
• Bachelor's degree is preferred but not required
• Professional designations such as AIC, ARM, or CPCU are preferred but not required

Why You'll Love Working Here

• 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


At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by:

• 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

This is where we shine, and we hire adjusters who want to shine with us.

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.

CCMSI offers comprehensive benefits including medical, dental, vision, life, and disability insurance. Paid time off accrues throughout the year in accordance with company policy, with paid holidays and eligibility for retirement programs in accordance with plan documents.

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

At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who:

• 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.

We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you.

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