Remote Workers Compensation Claim Adjuster California Claims Specialist

Ccmsi - Irvine, CA

Full-time - Senior

Remote - Irvine, CA

Insurance Carriers and Related Activities

About the position

The Workers' Compensation Claim Consultant, Senior at CCMSI is a fully remote role focused on managing California workers' compensation claims for a single client. This position requires a detail-oriented professional to handle complex cases, administer benefits, and oversee claim reviews, including litigated claims, while ensuring exceptional service and adherence to company standards.

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.
• Prepare reports detailing claim status, payments and reserves, as requested.
• Provide notices of qualifying claims to excess/reinsurance carriers.
• Conduct claim reviews and/or training sessions for clients, as requested.
• Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.
• Perform other duties as assigned.

Requirements

• 8+ years claim experience.
• Excellent oral and written communication skills.
• Initiative to set and achieve performance goals.
• Good analytic and negotiation skills.
• Ability to cope with job pressures in a constantly changing environment.
• Knowledge of all lower level claim position responsibilities.
• Detail oriented and a self-starter with strong organizational abilities.
• Ability to coordinate and prioritize required tasks.
• Flexibility, accuracy, initiative and the ability to work with minimum supervision.
• Discretion and confidentiality required.
• Reliable, predictable attendance within client service hours for the performance of this position.
• Responsive to internal and external client needs.

Nice-to-haves

• Adjuster's Certificate is preferred but not required.

Benefits

• 4 weeks of paid time off
• 10 paid holidays
• Health insurance
• Disability insurance
• Retirement benefits
• Employee Stock Ownership Plan (ESOP)
• 401K