Full-Time
Workers' Compensation Insurance Adjuster
CCMSI
1,001-5,000 employees
TPA for workers' comp and self-insurance
Compensation Overview
$80k - $98k/yr
No H1B Sponsorship
Irvine, CA, USA
Remote
Bachelor's
 Insurance (1) |
|---|
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- Five or more years of California Workers' Compensation claims experience managing full life-cycle claims.
- Demonstrated experience handling complex indemnity claims with minimal supervision.
- Hands-on experience calculating California Average Weekly Wage, including claims involving stipends, per diem, or other non-traditional wage components.
- Strong understanding of the California Labor Code and workers' compensation regulations related to wage determination and benefit calculations.
- Ability to independently evaluate and defend wage determinations when disputed.
- Proficiency with Microsoft Office products, including Word, Excel, and Outlook.
- An adjuster license is required as applicable by jurisdiction; a California SIP license is preferred or must be obtained within the first year of employment.
- Investigate, evaluate, and adjust Workers’ Compensation claims in accordance with established claim handling standards and California law.
- Independently manage complex indemnity claims, including claims involving traveling employees and variable wage structures.
- Calculate and document Average Weekly Wage in accordance with the California Labor Code, including analysis of stipends, per diem, and living allowances.
- Establish reserves or provide reserve recommendations within established authority levels.
- Review, approve, or provide oversight of medical, legal, damage estimate, and miscellaneous invoices to determine whether they are reasonable and related to designated claims, and negotiate disputed bills as needed.
- Authorize and issue claim payments in accordance with claim procedures, industry standards, and established payment authority.
- Negotiate settlements within Corporate Claim Standards, client-specific handling instructions, and applicable state laws.
- Assist in the selection, referral, and supervision of outside vendors, including legal counsel, surveillance, and case management vendors.
- Assess and monitor subrogation claims for resolution.
- Review and maintain an accurate personal diary in the claim system.
- Prepare claim status reports, payment summaries, and reserve reports as requested.
- Compute and adjust disability rates in compliance with California regulations.
- Maintain timely communication with clients, claimants, employers, attorneys, and vendors throughout the claim lifecycle.
- Attend and participate in hearings, mediations, Workers’ Compensation Appeals Board proceedings, and informal legal conferences as appropriate.
- Conduct claim reviews or training sessions for designated clients as requested.
- Provide notices of qualifying claims to excess and reinsurance carriers.
- Handle more complex and involved claims than lower-level claim positions with minimal supervision.
- Ensure compliance with Corporate Claim Handling Standards and special client handling instructions.
- Experience handling claims involving traveling or multi-location employees.
- Prior experience in a third-party administrator environment.
- A bachelor's degree is preferred but not required.
- Bilingual Spanish proficiency is highly valued for communicating with claimants, employers, and vendors.
CCMSI provides third-party administration services for workers' compensation and property/casualty self-insurance programs. It manages claims and offers risk management and cost-containment strategies for self-insured entities, including group self-insurance associations. The product works by acting as an administrator for a client’s self-insurance program: handling claims, administering payments, and implementing risk controls and cost-saving measures on a fee basis. CCMSI differentiates itself by focusing on the self-insurance niche and serving organizations that bear their own insurance risks, rather than selling traditional insurance policies. The company’s goal is to help clients reduce claim costs and manage their self-insurance programs more effectively.
Company Size
1,001-5,000
Company Stage
N/A
Total Funding
N/A
Headquarters
Danville, Illinois
Founded
1978
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Simplify's Take
What believers are saying
- Florida Insurance Trust moved historical and new claims to CCMSI on January 1, 2026.
- Data Dimensions partnered with CCMSI in October 2025, strengthening claims workflow infrastructure.
- CCMSI’s July 2026 Irvine office move suggests continued operational expansion and client servicing capacity.
What critics are saying
- BBB recorded 29 complaints in three years, including seven closed during 2026.
- California audit complaints against CCMSI reached 7,319 by July 2025, signaling compliance strain.
- Nevada’s March 24, 2026 reversal in Donovan v. City of Henderson keeps CCMSI exposed to claim disputes.
What makes CCMSI unique
- CCMSI calls itself the nation’s largest independent third-party administrator in 2026.
- Its 2026 Florida Insurance Trust transition shows broad workers’ compensation and liability coverage.
- Its iCE claims platform gives clients real-time visibility, supporting faster claims decisions.
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Benefits
Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Disability Insurance
Health Savings Account/Flexible Spending Account
Unlimited Paid Time Off
Paid Holidays
401(k) Company Match
Company Equity