Workers' Compensation Claim Specialist

Overview Workers' Compensation Claim Specialist Location: Irvine, CA - reporting remotely Schedule: Mon - Fri 8:00 am - 4:30 pm (PST - flexible start time) Salary Range: $88,000 - $92,000 (depending on experience) Build Your Career With Purpose at CCMSI At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success. We don’t just process claims—we support people. As the largest privately owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work®, and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day. Job Summary We are seeking a driven and compassionate Workers' Compensation Claim Specialist to join our team and make a meaningful impact in the lives of injured workers. In this role, you will take ownership of a dedicated portfolio of claims for a single fast-food client account , leading investigations, determining compensability, and guiding each case toward fair and timely resolution. This dedicated-account structure allows you to develop strong client relationships, gain in-depth knowledge of the client's operations, and become a trusted claims partner. This position offers the opportunity to grow your technical expertise and can serve as an advanced development path for future supervisory or management roles. As a Claim Specialist, you play a vital role in delivering the high-quality service our clients count on and upholding CCMSI's commitment to excellence. Responsibilities When 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 accordance with established claim handling standards and applicable laws. Establish reserves within assigned authority levels and provide notice of qualifying claims to excess or reinsurance carriers when appropriate. Review, approve and oversee medical, legal, damage estimates, invoices and other external vendor services to ensure they are reasonable, necessary and related to designated claims. Negotiate disputed bills and supervise referrals to outside vendors. Authorize and issue claim payments in accordance with claim procedures, industry standards and established authority levels. Negotiate settlements in accordance with Corporate Claim Standards, client-specific handling instructions and applicable laws. Review and maintain claim diaries within the claim management system. Assess and monitor subrogation opportunities through resolution. Compute disability rates in accordance with applicable state laws. Maintain effective and timely communication with clients, claimants and other stakeholders while ensuring compliance with Corporate Claim Handling Standards and client-specific handling instructions. Qualifications Required: 5+ years of California Workers’ Compensation claims handling experience , including full claim investigation, evaluation, and resolution. Must be able to travel one time a year. SIP and CA adjusters license is required. Experience handling litigated and lost time claims. Responsiveness to internal and external client needs. Strong analytical and negotiation abilities. Knowledge of all lower‑level claim position responsibilities. Nice to Have: Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required. Experience handling fast food claims Bachelor's degree is preferred but not required Professional designations such as AIC, ARM, or CPCU are preferred but not required 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 & Compliance The 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. ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations. Background checks, if required for the role, are conducted only after a conditional offer and in accordance with applicable fair chance hiring laws. Our Core Values At CCMSI, we believe in doing what’s right—for our clients, our coworkers, and ourselves. We look for team members who: Lead with transparency We build trust by being open and listening intently in every interaction. Perform with integrity We choose the right path, even when it is hard. Chase excellence We set the bar high and measure our success. What gets measured gets done. Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own. Win together Our greatest victories come when our clients succeed. We don’t just work together—we grow together. If that sounds like your kind of workplace, we’d love to meet you. #EmployeeOwned #GreatPlaceToWorkCertified #CCMSICareers #ESOP #InsuranceCareers #CaliforniaJobs #IrvineJobs #IND123 #LI-Remote