Workers' Compensation Claim Consultant

 

Workers’ Compensation Claim Consultant is responsible for investigating and managing assigned workers’ compensation claims while delivering high-quality service aligned with company standards and client expectations. This role also serves as a developmental opportunity for advancement into more senior claims 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.

• →Investigate, evaluate, and manage workers’ compensation claims in compliance with applicable laws and company standards
• →Establish and maintain appropriate claim reserves within authority limits
• →Review and approve medical, legal, and related expenses; resolve disputed invoices as needed
• →Authorize and process claim payments in line with procedures and industry standards
• →Negotiate settlements in accordance with company guidelines, client requirements, and state regulations
• →Coordinate with and oversee external vendors (e.g., legal, medical, surveillance, case management)
• →Monitor subrogation opportunities and pursue recovery when applicable
• →Maintain accurate claim documentation and follow-up activities within the claim system
• →Communicate effectively with clients, claimants, and other stakeholders to ensure timely updates and resolution
• →Prepare claim reports, including status updates, payments, and reserve changes
• →Calculate disability rates in accordance with state guidelines
• →Handle complex claims with minimal supervision
• →Participate in hearings, mediations, and other legal proceedings as needed
• →Support client relationships through claim reviews, training sessions, and high-quality service delivery
• →Ensure compliance with corporate claim standards and client-specific handling instructions

• California SIP or experienced adjuster license
• Excellent oral and written communication skills internally and externally
• 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.
• Must be detail oriented and a self-starter with strong organizational abilities. 
• Ability to coordinate and prioritize required. 
• Flexibility, accuracy, initiative and the ability to work with minimum supervision. 
• Discretion and confidentiality required. 
• Responsive to internal and external client needs.

 

• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required
• Experience with handling lost time and litigated claims
• Prior experience handling multiple accounts
• TPA experience 

• 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.

 

 

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. 

 

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