Workers' Compensation Claim Specialist

Overview Workers' Compensation Claim Specialist Location: Concord, CA (reporting remotely) Schedule: 8:00am-4:30pm Salary Range: $85,000 - $98,000 (depending on experience) 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 for a single healthcare account - managing a high level of complexity that includes both severe and litigated claims . You will lead investigations, determine compensability, and guide 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 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: 5+ years of Workers’ Compensation claims handling experience , including full claim investigation, evaluation, and resolution. Experience handling high level complexity healthcare account (including litigated claims) SIP Responsiveness to internal and external client needs. Strong analytical and negotiation abilities. Knowledge of all lower‑level claim position responsibilities. 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 Benefits 4 weeks Paid time off that accrues throughout the year in accordance with company policy + 10 paid holidays in your first year Comprehensive benefit packages: 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 Equal Opportunity Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations. CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. #J-18808-Ljbffr