Workers’ Claim Rep II; CA Expertise

Join to apply for the Workers’ Compensation Claim Rep II (CA Expertise Required) role at CCMSI

Location:

Hybrid or Remote – reporting to the Irvine, CA branch

Schedule:

Monday–Friday, 8:00 AM–4:30 PM PST

Salary Range: $70,000–$80,000 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 II to manage California workers’ compensation claims from intake through resolution for a PEO/Staffing account
. This role may be remote or hybrid, reporting to our Irvine, CA branch. This position is designed for an experienced adjuster who can independently manage claims, apply sound judgment, and deliver consistent results within California’s complex regulatory environment. You’ll handle more complex claim scenarios, contribute to claim strategy, and partner closely with supervisors, clients, and vendors to drive quality outcomes.

• Independently investigate, evaluate, and resolve California workers’ compensation claims in compliance with CCMSI standards and client handling instructions
• Manage claims cradle‑to‑grave, including compensability, medical management, litigation coordination, and resolution strategy
• Review medical, legal, and miscellaneous invoices for accuracy, reasonableness, and claim‑relatedness; negotiate disputed bills
• Establish, monitor, and adjust reserves in accordance with authority levels and best practices
• Authorize and issue claim payments within assigned settlement authority
• Negotiate settlements with injured workers and attorneys in accordance with client authorization
• Coordinate with and assist in the selection and oversight of defense counsel
• Identify and pursue subrogation opportunities
• Prepare and maintain accurate claim documentation, reports, payments, and reserve summaries
• Ensure compliance with service commitments, jurisdictional requirements, and excess reporting obligations
• Deliver consistent, high‑quality claim service aligned with CCMSI’s corporate standards

• 5–10 years of workers’ compensation claims experience, with demonstrated success handling California claims
• Proven ability to manage claims independently from intake through resolution
• Strong working knowledge of the California workers’ compensation claims process
• Excellent communication, organization, and time‑management skills
• Ability to prioritize work, meet deadlines, and manage a full caseload with minimal supervision
• 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…