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
California Workers' Compensation Claim Consultant to manage a complex portfolio of claims with confidence, empathy, and sound professional judgment. With 5+ years of hands-on claims experience, you will lead thorough investigations, guide claim strategy, and ensure fair, timely resolutions. This role also offers a strong development pathway for advancement into more senior claim positions. As a Claim Consultant, you will play a key role in delivering exceptional service to CCMSI clients and upholding our high standards of quality and responsiveness.
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 claims in compliance with company standards and applicable laws.
- Establish and manage reserves within authority guidelines.
- Review, approve, and negotiate medical, legal, damage estimate, and related claim expenses.
- Authorize claim payments and negotiate settlements within established authority and client-specific guidelines.
- Coordinate and oversee external vendors, including legal counsel, surveillance, and case management providers.
- Monitor claim progression, including subrogation opportunities, diary management, and reporting requirements.
- Maintain timely communication with clients, claimants, and other stakeholders throughout the claim lifecycle.
- Provide claim status updates, reserve analyses, and other reports as requested.
- Calculate disability rates and ensure compliance with applicable state regulations.
- Notify excess and reinsurance carriers of qualifying claims.
- Handle complex claims independently with minimal supervision.
- Participate in hearings, mediations, legal conferences, client meetings, training sessions, and claim reviews, as appropriate.
- Support client satisfaction through responsive service and adherence to corporate claim handling standards and client instructions.
- Contribute to special projects, training materials, newsletters, and other departmental initiatives as requested.
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.
