Overview
Workers’ Compensation Claim Representative I
Location: Hybrid or Remote - reporting to Irvine, CA branchSchedule: Monday–Friday, 8:00 AM–4:30 PM PSTSalary 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.
Responsibilities
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
Qualifications
What You’ll Bring
Required
1–3 years of workers’ compensation claims experienceor 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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