Workers’ Claim Rep ; CA Expertise

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Overview

Location:

Hybrid or Remote - reporting to Irvine, CA branch

Schedule:

Monday–Friday, 8:00 AM–4:30 PM PST
Salary Range: $60,000 to $70,000 annually (dependent on experience)

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.

We are seeking a Workers’ Compensation Claim Representative I to support a PEO/Staffing account handling California workers’ compensation claims from intake through resolution
. This role may be remote or hybrid, reporting to our Irvine, CA branch
.

This position is ideal for an early‑career adjuster or claims professional with 1–3 years of claims experience
—or a related insurance, medical, or legal background
—who is ready to grow in a true adjusting role. You’ll investigate claims, manage medical and legal activity, communicate with all parties, and deliver consistent, compliant outcomes under guidance and mentorship.

• Investigate and adjust California workers’ compensation claims in accordance with CCMSI standards and client handling instructions
• Manage claims cradle‑to‑grave, including compensability decisions, medical management, and resolution strategy
• Review medical, legal, and miscellaneous invoices for accuracy, reasonableness, and claim‑relatedness
• Negotiate disputed medical bills and work toward timely resolution
• Authorize and issue claim payments within assigned settlement authority
• Communicate with injured workers, employers, attorneys, medical providers, and internal partners
• Assist with settlement negotiations in accordance with client authorization
• Support the selection and coordination of defense counsel as appropriate
• Evaluate and monitor subrogation opportunities
• Prepare claim reports, payment summaries, and reserve documentation
• Maintain compliance with service commitments, jurisdictional requirements, and excess reporting obligations
• Deliver consistent, high‑quality claim service aligned with CCMSI’s corporate standards

• 1–3 years of workers’ compensation claims experience or related experience in insurance, medical claims, legal, or adjacent claim‑support roles
• Working knowledge of the California workers’ compensation claims process
• Strong organizational, communication, and time‑management skills
• Ability to prioritize work, meet deadlines, and manage multiple tasks
• Reliable, predictable attendance within established client service hours

• SIP designation or ability to obtain within a defined timeframe
• Associate degree or higher
• Experience supporting PEO and/or staffing accounts
• Proficiency with Microsoft Word, Excel, Outlook, and claims systems
• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.

• 4 weeks PTO + 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

• 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