Worker's Compensation Adjuster, TPA

CCMSI

. Investigate, evaluate, and adjust claims according to established claim handling standards and laws .

Posted 11/3/2026full-timeRemote • California • United StatesSeniorLead💰 $85,000 - $95,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive expertise in California Workers’ Compensation claims handling, including investigation, evaluation, and resolution, while ensuring compliance with corporate standards and state laws. Strong negotiation and communication skills are essential for managing complex claims and client interactions.

Highest-signal resume keywords

California Workers’ Compensation Claims HandlingClaim Investigation and ResolutionNegotiation SkillsAnalytical AbilitiesBilingual Spanish Proficiency

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims EvaluationClaims AdjustmentReserve RecommendationsDisability Rate ComputationSubrogation Claims Assessment

Soft Skills

Strong CommunicationResponsiveness to Client NeedsNegotiation Abilities

Tools & Technologies

Claim Payment ProgramClaim System

Certifications & Qualifications

CAWCSWCIRBCPWCWCCA

Industry Keywords

California Workers’ CompensationClaim Handling StandardsLitigated ClaimsClient InstructionsExcess/Reinsurance Carriers

About the role

Key responsibilities & impact

Investigate, evaluate, and adjust claims according to established claim handling standards and laws
Establish reserves or provide reserve recommendations within established authority levels
Review, approve, or oversee medical, legal, damage estimate, and miscellaneous invoices
Negotiate disputed bills and invoices for resolution
Authorize and make claim payments using a claim payment program and within established payment authority
Negotiate settlements according to corporate standards, client instructions, and state laws
Select, refer, and supervise claim files assigned to outside vendors
Review and maintain personal claim diaries in the claim system
Assess and monitor subrogation claims for resolution
Compute disability rates according to state laws
Coordinate timely communication with clients, claimants, and other relevant parties
Provide notices of qualifying claims to excess/reinsurance carriers
Comply with corporate claim handling standards and special client handling instructions
Manage a dedicated portfolio of California Workers’ Compensation claims from investigation through resolution

Requirements

What you’ll need

10+ years of California Workers’ Compensation claims handling experience, including full claim investigation, evaluation, and resolution
Worker’s Compensation Designation required: CAWCS, WCIRB, CPWC, or WCCA
Responsiveness to internal and external client needs
Strong analytical and negotiation abilities
Strong internal and external communication
Proven experience handling complex and litigated California claims
Knowledge of all lower-level claim position responsibilities
Visa sponsorship is not provided
Bilingual Spanish proficiency highly valued but not required
SIP preferred but not required
Bachelor’s degree preferred but not required

Benefits

Comp & perks

4 weeks paid time off that accrues throughout the year in accordance with company policy
10 paid holidays in the first year
Medical insurance
Dental insurance
Vision insurance
Life insurance
Disability insurance
401(k)
Employee Stock Ownership Plan (ESOP)
Internal training and advancement opportunities
Supportive, team-based work environment
Potential eligibility for bonuses or additional forms of pay
Reasonable accommodations throughout the application and hiring process