Workers' Compensation Claim Representative I

Location: Irvine, CA (Remote and Hybrid options)
Hours: Monday - Friday, 8:00 AM to 4:30 PM
Salary Range: $55,000 - $65,000

At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts. Certified as a Great Place To Work, our employee satisfaction and retention ranks in the 95th percentile.    

Reasons you should consider a career with CCMSI:

• Culture: Our Core Values are embedded into our culture of how we treat our employees as a valued partner-with integrity, passion and enthusiasm.
• Career development: CCMSI offers robust internships and internal training programs for advancement within our organization.
• Benefits: Not only do our benefits include 4 weeks paid time off in your first year, plus 10 paid holidays, but they also include Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP.
• Work Environment: We believe in providing an environment where employees enjoy coming to work every day, are provided the resources needed to perform their job and claims staff are assigned manageable caseloads.

The Workers' Compensation Claim Representative I is responsible for the investigation and adjustment of assigned workers compensation claims. This position may be used as an advanced training position for future consideration for promotion to a Work Comp Claim Rep II or more senior level claim position.  Accountable for the quality of claim services as perceived by CCMSI clients and within our corporate claim standards.

• Investigate and adjust workers compensation claims in accordance with established claims handling procedures using CCMSI guidelines and direct supervision. 
• Review medical, legal and miscellaneous invoices to determine if reasonable and related to the ongoing workers compensation claims. Negotiate any disputed bills for resolution. 
• Authorize and make payment of workers compensation claims utilizing a claim payment program in accordance with industry standards and within settlement authority. 
• Negotiate settlements with claimants and attorneys in accordance with client's authorization. 
• Assist in selection and supervision of defense attorneys. 
• Assess and monitor subrogation claims for resolution. 
• Prepare reports detailing claims, payments and reserves. 
• Provide reports and monitor files, as required by excess insurers. 
• Compliance with Service Commitments as established by team. 
• Delivery of quality claim service to clients.
• Performs other duties as assigned.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Excellent oral and written communication skills.
• Individual must be a self-starter with strong organizational abilities.
• Ability to coordinate and prioritize required.  
• Flexibility, initiative, and the ability to work with a minimum of direct supervision a must. 
• Discretion and confidentiality required. 
• Ability to work as a team member in a rapidly changing environment.

• Reliable, predictable attendance within client service hours for the performance of this position. 
• Responsive to internal and external client needs. 
• Ability to clearly communicate verbally and/or in writing both internally and externally.

Education and/or Experience    

3 or more years of workers compensation claim experience or other related industry experience is required.                     

Associates degree is preferred.

Computer Skills            

Proficient using Microsoft Office programs such as: Word, Excel, Outlook, etc. 

Certificates, Licenses, Registrations

Adjuster's license may be required based upon jurisdiction.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Work requires the ability to sit or stand up to 7.5 or more hours at a time.
• Work requires sufficient auditory and visual acuity to interact with others.

CORE VALUES & PRINCIPLES

Responsible for upholding the CCMSI Core Values & Principles which include: performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity; insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better; and leading by example.

CCMSI is an Affirmative Action / Equal Employment Opportunity employer offering an excellent benefit package including Medical, Dental, Prescription Drug, Vision, Flexible Spending, Life, ESOP and 401K.  

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.

CCMSI offers a comprehensive benefits package, which will be reviewed during the hiring process. Please contact our hiring team with any questions about compensation or benefits.

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. If you need assistance or accommodation, please contact our team.

Equal Opportunity Employer:
CCMSI is an Affirmative Action / Equal Employment Opportunity employer. We comply with all applicable employment laws, including pay transparency and fair chance hiring regulations. Background checks are conducted only after a conditional offer of employment.

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