Workers’ Compensation Claim Representative I

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 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.

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.

When we hire adjusters at CCMSI, we look for professionals who understand that every claim represents a real person’s livelihood, take ownership of outcomes, and see challenges as opportunities to solve problems with purpose and care.

• 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

What You’ll Bring

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

At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by:

• 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

This is where we shine, and we hire adjusters who want to shine with us

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

At CCMSI, we believe in doing what’s right—for our clients, our coworkers, and ourselves. We look for team members who:

• 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.

We don’t just work together—we grow together. If that sounds like your kind of workplace, we’d love to meet you.

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