OverviewWorkers' Compensation Claim Consultant - Senior (California)Location: Irvine, CA (100% remote)
Salary Range: $80,000 - $98,000 (dependent on experience)
License Requirement: California SIP preferred or ability to obtain within first year of employment
Job SummaryWe are seeking an experienced and highly skilled
Senior Workers' Compensation Claim Consultant to manage a complex California claims portfolio, including claims involving traveling and multi-location employees with stipend and per diem wage structures. This role requires advanced professional judgment, strong regulatory knowledge, and the ability to independently manage wage calculations, claim strategy, and dispute resolution.
With
5+ years of hands-on California workers' compensation claims experience, you will lead thorough investigations, guide complex claim strategies, and ensure fair, timely, and compliant resolutions. This role is designed for a seasoned adjuster who thrives in gray areas, particularly around California wage determination and Average Weekly Wage (AWW) calculations, and who can confidently defend those determinations when challenged.
As a Claim Consultant, you will play a key role in delivering exceptional service to CCMSI clients while upholding our high standards of quality, accuracy, and responsiveness. This role also offers a strong development pathway into more senior claim positions.
This is a full life-cycle WC adjuster position within a TPA environment, and only candidates with proven Workers' Compensation claims experience will be considered.
ResponsibilitiesWhen 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 Workers' Compensation claims in accordance with established claim handling standards and California law.
- Independently manage complex indemnity claims, including those involving traveling employees and variable wage structures.
- Calculate and document Average Weekly Wage (AWW) in accordance with California Labor Code, including analysis of stipends, per diem, and living allowances.
- Establish reserves and/or provide reserve recommendations within established 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 disputed bills as needed.
- Authorize and issue claim payments in accordance with claim procedures, industry standards, and established payment authority.
- Negotiate settlements within Corporate Claim Standards, client-specific handling instructions, and applicable state laws.
- Assist in the selection, referral, and supervision of outside vendors (e.g., legal counsel, surveillance, case management).
- Assess and monitor subrogation claims for resolution.
- Review and maintain an accurate personal diary in the claim system.
- Prepare claim status reports, payment summaries, and reserve reports as requested.
- Compute and adjust disability rates in compliance with California regulations.
- Maintain effective, timely communication with clients, claimants, employers, attorneys, and vendors throughout the claim lifecycle.
- Attend and participate in hearings, mediations, WCAB proceedings, and informal legal conferences, as appropriate.
- Conduct claim reviews and/or training sessions for designated clients, as requested.
- Provide notices of qualifying claims to excess and reinsurance carriers.
- Handle more complex and involved claims than lower-level claim positions with minimal supervision.
- Ensure compliance with Corporate Claim Handling Standards and special client handling instructions.
QualificationsRequired Qualifications- Five (5) or more years of California Workers' Compensation claims experience, managing full life-cycle claims.
- Demonstrated experience handling complex indemnity claims with minimal supervision.
- Hands-on experience calculating California AWW, including claims involving stipends, per diem, or other non-traditional wage components.
- Strong understanding of California Labor Code and WC regulations related to wage determination and benefit calculations.
- Ability to independently evaluate and defend wage determinations when disputed.
- Proficiency with Microsoft Office products, including Word, Excel, and Outlook.
- Adjuster license as required by jurisdiction; California SIP preferred or ability to obtain within the first year of employment.
Preferred Qualifications- Experience handling claims involving traveling or multi-location employees.
- Prior experience in a TPA environment.
- Bachelor's degree preferred but not required.
- Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, and vendors.
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 & ComplianceThe 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.
