Delivering what matters most.
WC Claim Consultant (California Claims)
Location
United States
Posted
94 days ago
Salary
$75K - $95K / year
Seniority
Mid Level
No structured requirement data.
Job Description
WC Claim Consultant (California Claims)
CCMSI
Overview Workers' Compensation Claim Consultant (California Claims)Location: Las Vegas, Nevada (Will Report Remotely) Schedule: 8:00 am - 4:30pm Salary Range: $75,000 - $95,000 (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 an experienced and highly skilled Workers’ Compensation Claim Consultant to manage a complex portfolio of claims with confidence, empathy, and sound professional judgment. With 5+ years of hands‑on claims experience, you will lead thorough investigations, guide claim strategy, and ensure fair, timely resolutions. This role also offers a strong development pathway for advancement into more senior claim positions. As a Claim Consultant, you will play a key role in delivering exceptional service to CCMSI clients and upholding our high standards of quality and responsiveness. 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. This is not an HR position. 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 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. - Review and maintain personal diary on claim system. - Client satisfaction. - Prepare reports detailing claim status, payments and reserves, as requested. - Compute disability rates in accordance with state laws. - Effective and timely coordination of communication with clients, claimants and appropriate parties throughout the claim adjustment process. - Prepare newsletter articles, as requested. - Provide notices of qualifying claims to excess/reinsurance carriers. - Handle more complex and involved claims than lower level claim positions with minimum supervision. - Conduct claim reviews and/or training sessions for designated clients, as requested. - Attend and participate at hearings, mediations, and informal legal conferences, as appropriate. - Compliance with Corporate Claim Handling Standards and special client handling instructions as established. Qualifications Required Qualifications - Five or more years of California Workers’ Compensation claims experience. - Proficiency with Microsoft Office products, including Word, Excel, and Outlook. - Adjuster’s license may be required based on jurisdiction. Preferred Qualifications - Bachelor’s degree is preferred but not required. - SIP Preferred, but not required - Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, 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. #CCMSICareers #EmployeeOwned #GreatPlaceToWorkCertified #ESOP #TPA #InsuranceCareers #NowHiring #ClaimsCareers #RemoteWork #IND123 #LI-Remote
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Claims Technical Specialist - Construction Defect (Remote)
Selective Insurance Company of AmericaSelective is a midsized U.S. domestic property and casualty insurance company with a history of strong, consistent financial performance for nearly 100 years. Selective's unique position as both a leading insurance group and an employer of choice is recognized in a wide variety of awards and honors, including listing in Forbes Best Midsize Employers in 2025 and certification as a Great Place to Work® in 2025 for the sixth consecutive year. Employees are empowered and encouraged to Be Uniquely You by being their true, unique selves and contributing their diverse talents, experiences, and perspectives to our shared success.
About Us At Selective, we don't just insure uniquely, we employ uniqueness. Selective is a midsized U.S. domestic property and casualty insurance company with a history of strong, consistent financial performance for nearly 100 years. Selective's unique position as both a leading insurance group and an employer of choice is recognized in a wide variety of awards and honors, including listing in Forbes Best Midsize Employers in 2025 and certification as a Great Place to Work® in 2025 for the sixth consecutive year. Employees are empowered and encouraged to Be Uniquely You by being their true, unique selves and contributing their diverse talents, experiences, and perspectives to our shared success. Together, we are a high-performing team working to serve our customers responsibly by helping to mitigate loss, keep them safe, and restore their lives and businesses after an insured loss occurs. Overview Selective Insurance is seeking a Claims Technical Specialist-Construction Defect for this remote position. This role will investigate, negotiate and conclude by settlement or denial complex and challenging claims. The individual in this position will also ensure claims are processed within company policies, procedures, and individual's prescribed authority with exceptional standards of performance. All job duties and responsibilities must be carried out in compliance with applicable legal and regulatory requirements. Responsibilities - Investigate the claims through telephone, written correspondence, and/or personal contact with claimants, attorneys, insureds, witnesses and others having pertinent information. - Analyze information in order to evaluate assigned claims to determine the extent of loss, taking into consideration contributory or comparative negligence. Assign medical or other experts to case and arrange for medical examinations when necessary. - Process incoming calls and correspondence from insureds, claimants and agents regarding questions or problems associated with claims. Interact with underwriters and agents on claim resolution. - Evaluate, negotiate and settle both non-litigated and litigated claims within delegated authority. Handle litigation files from start to finish. - Update ACS on a continual basis to accurately reflect status of each assigned fie and to initiate percentage of negligence on the part of the insured to determine "chargeablity". - Receive and approve expenses incurred to investigate, process, and handle a claim. - Prepare check requisitions for all loss and expense payments. - Explore salvage and subrogation potential on all claims. Prepare for and participate in claims review and settlement conferences. - Close claim by issuing check or denial and securing appropriate releases. - Must be able to drive an automobile to travel within territory. Car travel represents approximately 0-10% of employee’s time and a valid driver’s license. Qualifications Knowledge and Requirements - Must be able to handle litigation files from start to finish. 80% to 90% of CD files are in suit or expected to be litigated. - Must understand and interpret policy forms and endorsements that may limit or exclude coverage. - Must understand and interpret Named Insured role and obligations to others (GC, sub, sub-sub, etc.). - Must be able to determine Additional Insured obligations, if any. - Must be able to evaluate contractual obligations and their effect on coverage. - Ability to author Coverage Position Letters (ROR, Disclaimers, etc.) to submit for approval by management. - Ability to recognize coverage issues that require evaluation by the internal coverage team and/or outside coverage counsel. - Recognition of potential early settlement opportunities and willingness to recommend business decisions to resolve. Education and Experience - College degree preferred. - Prefer 7-10 years claims experience. - 5+ years with handling construction defect claims that involve complex coverage analysis and moderate to high loss evaluations. Total Rewards Selective Insurance offers a total rewards package that includes a competitive base salary, incentive plan eligibility at all levels, and a wide array of benefits designed to help you and your family stay healthy, achieve your financial goals, and balance the demands of your work and personal life. These benefits include comprehensive health care plans, retirement savings plan with company match, discounted Employee Stock Purchase Program, tuition assistance and reimbursement programs, and 20 days of paid time off. Additional details about our total rewards package can be found by visiting our benefits page. The actual base salary is based on geographic location, and the range is representative of salaries for this role throughout Selective's footprint. Additional considerations include relevant education, qualifications, experience, skills, performance, and business needs. Pay Range USD $96.00 - USD $125,000.00 /Yr. Additional Information Selective is an Equal Employment Opportunity employer. That means we respect and value every individual’s unique opinions, beliefs, abilities, and perspectives. We are committed to promoting a welcoming culture that celebrates diverse talent, individual identity, different points of view and experiences – and empowers employees to contribute new ideas that support our continued and growing success. Building a highly engaged team is one of our core strategic imperatives, which we believe is enhanced by diversity, equity, and inclusion. We expect and encourage all employees and all of our business partners to embrace, practice, and monitor the attitudes, values, and goals of acceptance; address biases; and foster diversity of viewpoints and opinions. For Massachusetts Applicants It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.


