Workers' Claim Adjuster, Sr. (CA Claims - Remote

Senior Workers' Compensation Claims Specialist

Location:

Remote (Concord, CA)

Schedule:

Monday – Friday 8:00 am – 4:30 pm PST

Salary Range: $87,000 – $97,000

Build Your Career With Purpose  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.

The Senior Workers’ Compensation Claim Specialist is responsible for managing the investigation and resolution of assigned workers’ compensation claims. This advanced development opportunity is intended for individuals being considered for future supervisory or management positions. The Senior Specialist ensures the delivery of high‑quality claims services that meet CCMSI’s corporate standards and client expectations. This is a true adjusting position; candidates must have proven experience conducting full investigation, evaluation, negotiation, and resolution of workers’ compensation claims, with end‑to‑end file ownership and decision‑making authority.

Applicants without direct claims‑adjusting experience will not be considered.

• Investigate, evaluate and adjust claims in accordance with established claim handling standards and laws.
• Establish reserves and provide reserve recommendations within established reserve authority levels.
• Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine reasonableness and relevance; negotiate disputed bills or invoices.
• Authorize payments of claims per claim procedures, within industry standards and established payment authority.
• Negotiate settlements in accordance with corporate claim standards, client handling instructions and state laws.
• Assist in the selection, referral and supervision of designated claim files sent to outside vendors (e.g., legal, surveillance, case management).
• Maintain a personal diary on the claim system.
• Assess and monitor subrogation claims for resolution.
• Compute disability rates in accordance with state laws.
• Coordinate communication with clients, claimants and other parties throughout the claim adjustment process.
• Provide notices of qualifying claims to excess/reinsurance carriers.
• Maintain compliance with corporate claim handling standards and special client handling instructions.

• Strong oral and written communication skills
• 15 years of workers’ compensation claim adjusting
• Effective analytical and negotiation skills
• Ability to set and achieve performance goals with initiative
• Ability to manage multiple client accounts and competing priorities
• Comprehensive knowledge of lower‑level claims role responsibilities
• Experience adjusting lost‑time claims and managing litigated files
• Detail‑oriented, self‑motivated, and highly organized
• Ability to coordinate, prioritize, and work with minimal supervision
• Flexible, accurate, and proactive approach to work
• Commitment to discretion and confidentiality
• Reliable and predictable attendance during client service hours
• Responsive to internal and external client needs
• Proficiency in Microsoft Office (Word, Excel, Outlook)
• California jurisdiction experience required

• Bilingual (Spanish) proficiency – highly valued for communicating with claimants, employers, or vendors, but not required

• California SIP certification
• Claim review presentation experience
• AIC, ARM, or CPCU designation

• 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
• Pro…