Workers' Compensation Claim Specialist

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—leading investigations, determining compensability, and guiding each case toward a fair and timely resolution. 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

• 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.
• Absorb and maintain personal diary on claim system.
• 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.
• Compliance with Corporate Claim Handling Standards and special client handling instructions as established.

Qualifications

• 5+ years of Workers’ Compensation claims handling experience, including full claim investigation, evaluation, and resolution.
• Responsiveness to internal and external client needs.
• Ability to handle multiple accounts.
• 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.
• Bachelor's degree is preferred but not required.
• Professional designations such as AIC, ARM, or CPCU are preferred but not required.
• SIP maybe 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
• Retail plans : 401(k) and Employee Stock Ownership Plan (ESOP)
• Career growth : Internal training and advancement opportunities
• Culture : A supportive, team-based work environment

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.

Background checks, if required for the role, are conducted only after a conditional offer and in accordance with applicable fair chance hiring regulations.

Our Core Values

• 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.
• We perform with integrity
• We choose the right path, even when it is hard.
• We chase excellence
• We what gets measured gets done.
• We own the outcome
• We win together
• We don’t just work together—we grow together.