Workers' Compensation Claim Specialist

Overview 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. Position Workers' Compensation Claim Specialist Location: Concord, CA Schedule: 8:00am – 4:30pm (PST) Salary Range: $85,000 - $95,000 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 We are seeking a driven and compassionate Workers’ Compensation Claim Specialist to join our team and make a meaningful impact in the lives of injured workers. In this role, you will take ownership of a dedicated portfolio of claims—leading investigations, determining compensability, and guiding each case toward a fair and timely resolution. This position offers the opportunity to grow your technical expertise and can serve as an advanced development path for future supervisory or management roles. As a Claim Specialist, you play a vital role in delivering the high‑quality service our clients count on and upholding CCMSI’s commitment to excellence. 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 (e.g., legal, surveillance, case management). Review and maintain personal diary on claim system. Assess and monitor subrogation claims for resolution. Compute disability rates in accordance with state laws. Coordinate timely 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 client-specific instructions. Qualifications Required: 5+ years of Workers’ Compensation claims handling experience, including full claim investigation, evaluation, and resolution. Responsiveness to internal and external client needs. Ability to handle multiple accounts. Strong analytical and negotiation abilities. Knowledge of all lower‑level claim position responsibilities. Adjuster’s license may be required based on jurisdiction. Nice To Have Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required. Bachelor's degree is preferred but not required Professional designations such as AIC, ARM, or CPCU are preferred but not required SIP may be required. Why You’ll Love Working Here 4 weeks of paid time off that accrues throughout the year in accordance with company policy, plus 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. 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. Note: This job description contains promotional language and hashtags that have been removed for clarity and compliance. #J-18808-Ljbffr