Workers' Compensation Claim Adjuster (California Claims) (Remote)
Irvine, CA Irvine, CA Full-time Full-time Estimated:
$51.
4K - $65.
1K a year Estimated:
$51.
4K - $65.
1K a year 10 days ago 10 days ago 10 days ago Overview:
At CCMSI, we are in search of the best and brightest talent to join our team of professionals.
As a leading Third Party Administrator in self-insurance services, we are driven by our common purpose of delivering exceptional service to our clients.
As an Employee-Owned Company, we prioritize the development of our staff through structured career development programs, while rewarding and recognizing individual and team efforts.
Certified as a Great Place To Work, we take pride in our employee satisfaction and retention, which ranks in the 95th percentile.
Why Consider a Career with CCMSI:
Culture:
Our Core Values are deeply ingrained in our culture, shaping how we treat our employees as valued partners--with integrity, passion, and enthusiasm.
Career Development:
CCMSI offers robust internships and internal training programs designed to foster advancement within our organization.
Benefits:
Our benefits package is comprehensive, including 4 weeks of paid time off in your first year, 10 paid holidays, and coverage for Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP (Employee Stock Ownership Plan).
Work Environment:
We believe in providing an environment where employees enjoy coming to work every day, have the necessary resources to excel at their jobs, and where claims staff are assigned manageable caseloads.
Position:
Workers' Compensation Claim Adjuster, Mid to Senior level
Responsibilities:
As a Workers' Compensation Claim Adjuster, you will be responsible for the investigation and adjustment of assigned claims.
You will manage a caseload of workers' compensation claims with moderate to high complexity and exposure.
Your role will play a crucial part in ensuring the quality of claim services meets CCMSI client expectations and adheres to our corporate claim standards.
Your key responsibilities will include:
Investigate, evaluate, and adjust claims in compliance with established claim handling standards and laws.
Establish reserves and/or provide reserve recommendations within defined authority levels.
Review, approve, or oversee medical, legal, damage estimates, and miscellaneous invoices to determine reasonableness and relevance to designated claims.
Negotiate disputed bills or invoices for resolution.
Authorize and make payments of claims in accordance with claim procedures, utilizing a claim payment program and adhering to industry standards and established payment authority.
Negotiate settlements in accordance with 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 (e.
g.
, legal, surveillance, case management).
Assess and monitor subrogation claims for resolution.
Compute disability rates in compliance with state laws.
Coordinate effective and timely communication with clients, claimants, and other relevant parties throughout the claim adjustment process.
Provide notices of qualifying claims to excess/reinsurance carriers.
Handle more complex and involved claims compared to intermediate/lower level positions with minimal supervision, as requested.
Attend and actively participate in hearings, mediations, and informal legal conferences, as deemed necessary.
Supervise all claim activity for specified accounts.
Ensure compliance with Corporate Claim Handling Standards and special client handling instructions.
Perform other duties as assigned.
Qualifications:
To succeed in this role, you must be able to perform each essential duty satisfactorily.
The following qualifications are representative of the knowledge, skills, and abilities required:
2
years of California Workers' Compensation Claim experience, including investigating, adjusting, and settling claims.
High School Diploma or GED is required.
California SIP is required.
California Claims Adjuster Designation is required.
Exposure to lost time/Indemnity claims.
Demonstrated knowledge of workers' compensation laws and regulations.
Proficiency in Microsoft Office programs, including Word, Excel, Outlook, etc.
Excellent oral and written communication skills.
Proven initiative in setting and achieving performance goals.
Strong analytical and negotiation skills.
Ability to thrive in a fast-paced, changing environment.
Familiarity with lower-level claim position responsibilities.
Detail-oriented and self-motivated with strong organizational abilities.
Ability to coordinate and prioritize tasks effectively.
Flexibility, accuracy, initiative, and the ability to work with minimum supervision.
Discretion and commitment to maintaining confidentiality.
Reliable and predictable attendance within client service hours for this position's performance.
Responsiveness to internal and external client needs.
Clear and effective verbal and written communication internally and externally.
Ability to sit and/or stand for extended periods.
Core Values & Principles:
At CCMSI, we expect all employees to uphold our Core Values & Principles, which include:
Performing with integrity.
Passionately focusing on client service.
Embracing a client-centered vision.
Maintaining contagious enthusiasm for our clients.
Searching for the best ideas.
Viewing 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.
Building constructive relationships.
Taking the initiative to make things better.
Leading by example.
Additional Information:
CCMSI is an Affirmative Action / Equal Employment Opportunity employer, offering an excellent benefits package, including Medical, Dental, Prescription Drug, Vision, Flexible Spending, Life, ESOP, and 401K.
Keywords:
Workers' Compensation, Work Comp, Claims Examiner, Claims Adjuster, Claims Specialist, Great Place to Work, Remote Work We appreciate your interest in joining our team at CCMSI!.
Estimated Salary: $20 to $28 per hour based on qualifications.
$51.
4K - $65.
1K a year Estimated:
$51.
4K - $65.
1K a year 10 days ago 10 days ago 10 days ago Overview:
At CCMSI, we are in search of the best and brightest talent to join our team of professionals.
As a leading Third Party Administrator in self-insurance services, we are driven by our common purpose of delivering exceptional service to our clients.
As an Employee-Owned Company, we prioritize the development of our staff through structured career development programs, while rewarding and recognizing individual and team efforts.
Certified as a Great Place To Work, we take pride in our employee satisfaction and retention, which ranks in the 95th percentile.
Why Consider a Career with CCMSI:
Culture:
Our Core Values are deeply ingrained in our culture, shaping how we treat our employees as valued partners--with integrity, passion, and enthusiasm.
Career Development:
CCMSI offers robust internships and internal training programs designed to foster advancement within our organization.
Benefits:
Our benefits package is comprehensive, including 4 weeks of paid time off in your first year, 10 paid holidays, and coverage for Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP (Employee Stock Ownership Plan).
Work Environment:
We believe in providing an environment where employees enjoy coming to work every day, have the necessary resources to excel at their jobs, and where claims staff are assigned manageable caseloads.
Position:
Workers' Compensation Claim Adjuster, Mid to Senior level
Responsibilities:
As a Workers' Compensation Claim Adjuster, you will be responsible for the investigation and adjustment of assigned claims.
You will manage a caseload of workers' compensation claims with moderate to high complexity and exposure.
Your role will play a crucial part in ensuring the quality of claim services meets CCMSI client expectations and adheres to our corporate claim standards.
Your key responsibilities will include:
Investigate, evaluate, and adjust claims in compliance with established claim handling standards and laws.
Establish reserves and/or provide reserve recommendations within defined authority levels.
Review, approve, or oversee medical, legal, damage estimates, and miscellaneous invoices to determine reasonableness and relevance to designated claims.
Negotiate disputed bills or invoices for resolution.
Authorize and make payments of claims in accordance with claim procedures, utilizing a claim payment program and adhering to industry standards and established payment authority.
Negotiate settlements in accordance with 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 (e.
g.
, legal, surveillance, case management).
Assess and monitor subrogation claims for resolution.
Compute disability rates in compliance with state laws.
Coordinate effective and timely communication with clients, claimants, and other relevant parties throughout the claim adjustment process.
Provide notices of qualifying claims to excess/reinsurance carriers.
Handle more complex and involved claims compared to intermediate/lower level positions with minimal supervision, as requested.
Attend and actively participate in hearings, mediations, and informal legal conferences, as deemed necessary.
Supervise all claim activity for specified accounts.
Ensure compliance with Corporate Claim Handling Standards and special client handling instructions.
Perform other duties as assigned.
Qualifications:
To succeed in this role, you must be able to perform each essential duty satisfactorily.
The following qualifications are representative of the knowledge, skills, and abilities required:
2
years of California Workers' Compensation Claim experience, including investigating, adjusting, and settling claims.
High School Diploma or GED is required.
California SIP is required.
California Claims Adjuster Designation is required.
Exposure to lost time/Indemnity claims.
Demonstrated knowledge of workers' compensation laws and regulations.
Proficiency in Microsoft Office programs, including Word, Excel, Outlook, etc.
Excellent oral and written communication skills.
Proven initiative in setting and achieving performance goals.
Strong analytical and negotiation skills.
Ability to thrive in a fast-paced, changing environment.
Familiarity with lower-level claim position responsibilities.
Detail-oriented and self-motivated with strong organizational abilities.
Ability to coordinate and prioritize tasks effectively.
Flexibility, accuracy, initiative, and the ability to work with minimum supervision.
Discretion and commitment to maintaining confidentiality.
Reliable and predictable attendance within client service hours for this position's performance.
Responsiveness to internal and external client needs.
Clear and effective verbal and written communication internally and externally.
Ability to sit and/or stand for extended periods.
Core Values & Principles:
At CCMSI, we expect all employees to uphold our Core Values & Principles, which include:
Performing with integrity.
Passionately focusing on client service.
Embracing a client-centered vision.
Maintaining contagious enthusiasm for our clients.
Searching for the best ideas.
Viewing 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.
Building constructive relationships.
Taking the initiative to make things better.
Leading by example.
Additional Information:
CCMSI is an Affirmative Action / Equal Employment Opportunity employer, offering an excellent benefits package, including Medical, Dental, Prescription Drug, Vision, Flexible Spending, Life, ESOP, and 401K.
Keywords:
Workers' Compensation, Work Comp, Claims Examiner, Claims Adjuster, Claims Specialist, Great Place to Work, Remote Work We appreciate your interest in joining our team at CCMSI!.
Estimated Salary: $20 to $28 per hour based on qualifications.
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