CCMSI
Workers’ Compensation Claim Rep I (CA Expertise Required)
CCMSI, California, Missouri, United States, 65018
Workers’ Compensation Claim Rep I (CA Expertise Required)
- Join to apply for this role at
CCMSI
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).
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 our clients’ 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 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.
Responsibilities
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
Qualifications Required
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
Preferred
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.
Why You’ll Love Working Here
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
How We Measure Success
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
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.
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.
Our Core Values
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.
Job Details
Seniority level: Entry level
Employment type: Full‑time
Job function: Human Resources
Industries: Insurance
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- Join to apply for this role at
CCMSI
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).
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 our clients’ 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 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.
Responsibilities
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
Qualifications Required
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
Preferred
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.
Why You’ll Love Working Here
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
How We Measure Success
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
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.
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.
Our Core Values
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.
Job Details
Seniority level: Entry level
Employment type: Full‑time
Job function: Human Resources
Industries: Insurance
#J-18808-Ljbffr