Overview:
Workers' Compensation Senior Claim Specialist – Remote (California)
Join our team of experienced professionals at CCMSI, a leading Third Party Administrator in self-insurance services. We are currently seeking a highly skilled Workers' Compensation Senior Claim Specialist to manage a dedicated client desk, focusing exclusively on California jurisdiction. This position is fully remote, Monday through Friday, from 8:00 AM to 4:30 PM.
Key Responsibilities:
- Investigate and adjust California workers' compensation claims for a dedicated client.
- Deliver exceptional customer service and ensure claim quality meets both client expectations and corporate standards.
- Utilize your deep knowledge of California workers' compensation laws, with an emphasis on providing superior claim management and resolution.
Required Skills and Experience:
- 15+ years of workers' compensation claims experience, with a strong emphasis on California claims.
- Self-Insurance Plans (SIP) certification is required.
- WCCP designation is preferred.
- Proven track record of outstanding customer service and client management.
- Excellent computer skills and the ability to efficiently work within claims management systems.
- Strong time management, attention to detail, and organizational skills.
Why Join CCMSI?
At CCMSI, we are committed to providing our employees with opportunities for growth and success. As an Employee-Owned Company, we recognize and reward individual and team efforts, and we focus on career development through structured programs. Here’s why you should consider a career with us:
- Culture: Our core values—integrity, passion, and enthusiasm—guide how we treat our employees as valued partners.
- Career Development: We offer robust training programs, providing opportunities for professional growth and promotion.
- Work-Life Balance: Enjoy 4 weeks of paid time off in your first year, 10 paid holidays, and manageable caseloads.
- Comprehensive Benefits: Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long-Term Disability, 401K, and ESOP.
About CCMSI: Certified as a Great Place To Work, we are proud of our employee satisfaction and retention, ranking in the 95th percentile. At CCMSI, we are united by our commitment to delivering exceptional service to our clients, and we offer a supportive and positive work environment for all employees.
Take the next step in your career and apply today to join a company that values your experience and offers you the resources to thrive!
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.)
- Assess and monitor subrogation claims for resolution.
- Compute disability rates in accordance with state laws.
- Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the claim adjustment process.
- Provide notices of qualifying claims to excess/reinsurance carriers.
- Handle more complex and involved claims than intermediate/lower level claims positions with minimum supervision, as requested.
- Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.
- Supervision of all claim activity for specified accounts.
- Compliance with Corporate Claim Handling Standards and special client handling instructions as established.
- Performs other duties as assigned.
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
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.
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.
Reliable, predictable attendance within client service hours for the performance of this position.
Responsive to internal and external client needs.
Ability to clearly communicate verbally and/or in writing both internally and externally.
Education and/or Experience
15+ years claim experience is required.
Computer Skills
Proficient using Microsoft Office programs such as Word, Excel, Outlook, etc.
Certificates, Licenses, Registrations
Self-Insurance Plans (SIP) certification is required.
AIC Designation preferred.
WCCP designation is preferred.
CORE VALUES & PRINCIPLES
Responsible for upholding the CCMSI Core Values & Principles which include: performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon 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; maintaining constructive relationships; taking the initiative to make things better; and leading by example.
CCMSI is an Affirmative Action / Equal Employment Opportunity employer offering an excellent benefit package including Medical, Dental, Prescription Drug, Vision, Flexible Spending, Life, ESOP and 401K.
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