Senior Workers' Compensation Adjuster- California Claims (Remote)

Overview

Workers’ Compensation Claim Specialist

Location: RemoteHours: Monday - Friday, 8:00 AM to 4:30 PMSalary Range: $70,000 - $95,000

Position Summary:

The Workers’ Compensation Claim Specialist will oversee a multiple-account desk within the California jurisdiction, investigating and adjusting assigned Workers' Compensation claims to ensure high-quality service. This role requires a CA Self-Insurance Plan (SIP) or experienced adjuster certificate and at least 10 years of California Workers' Compensation claim handling experience. Bilingual proficiency in Spanish is highly desired. This position also provides an excellent opportunity for growth, potentially serving as a training ground for more senior claims roles.

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. (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.
• Performs other duties as assigned.

Qualifications

Performance Metrics:

• • Timely compensability decision-making
  • Accurate and prompt indemnity payments
  • Effective diary management and medical bill processing
  • Adherence to best practices in claim handling

• Experience: Minimum of 10 years of California Workers' Compensation claim handling experience. Bachelor’s degree preferred.
• Certification: CA SIP or experienced adjuster certificate required.
• Skills: Strong analytical, communication, and negotiation skills; detail-oriented, self-motivated, and capable of managing pressures in a dynamic environment.
• Computer Skills: Proficient in Microsoft Office.
• Language: Bilingual (Spanish) highly desired.

 

Working Conditions:

• Physical Demands: Light lifting, extended periods of sitting or standing, and sufficient auditory and visual acuity for interaction.

Core Values & Principles:

Employees are expected to uphold CCMSI’s Core Values and Principles,

performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity; insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better; and leading by example.

 

Disclaimer: "The posted salary range for this position reflects the anticipated base pay for this role. Actual pay is determined based on factors such as qualifications, skills, relevant experience, internal equity, and location. Additional compensation may include discretionary bonuses, benefits, or other forms of compensation, depending on the role. The salary range provided is in compliance with state and local requirements and is intended to offer transparency to applicants. We encourage open discussions with our hiring team regarding any questions you may have about compensation and benefits for this position."

 

CCMSI is an Affirmative Action / Equal Employment Opportunity employer