Workers’ Compensation Claim Representative II

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)

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 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.

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.

• 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

What You’ll Bring

Required

• 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

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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