Overview
Workers' Compensation Claim Representative II (Bilingual - Spanish)
Location: Remote (Must reside in a location that allows regular travel to Irvine, CA a few times per year)
Schedule: Monday–Friday, 8:00 a.m. – 4:30 p.m. PST (37.5 hours per week)
Salary Range: $65,000 – $80,000 annually (commensurate with 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’re seeking a Workers’ Compensation Claim Representative II to handle California WC claims for a single carrier client. This is a great role for an experienced adjuster who is confident with full claim ownership—from investigation to resolution—and who thrives in a fast‑paced environment.
This position requires excellent communication skills, strong technical knowledge of CA Workers’ Compensation, and the ability to work independently while remaining connected to a supportive team of fewer than 20 colleagues.
Bilingual English/Spanish proficiency (spoken & written) is required, and used regularly in claimant, employer, and provider communication.
Responsibilities
When we hire adjusters, we look for professionals who take ownership of their work, navigate complexity with confidence, and deliver exceptional service with integrity. In this role, you’ll be trusted to manage your files independently while contributing to a collaborative, high‑performing team.
What You’ll Do
- Investigate, evaluate, and adjust California workers’ compensation claims in alignment with jurisdictional requirements and CCMSI standards
- Communicate clearly with injured workers, employers, providers, attorneys, and other stakeholders
- Review, approve, and negotiate medical, legal, and miscellaneous invoices
- Determine compensability and authorize benefits within settlement authority
- Negotiate settlements with claimants and attorneys
- Coordinate and supervise defense counsel as needed
- Handle subrogation opportunities and ensure proper recovery efforts
- Prepare detailed reports on claims, reserves, and financial activity
- Monitor files for excess reporting requirements
- Maintain timely diary queues, document queues, and respond to audit standards
- Support client service commitments with accuracy and urgency
Qualifications
Required:
- Active California Adjuster License
- 5–10 years of workers’ compensation claim adjusting experience
- Bilingual (English/Spanish) — spoken and written
- Strong organizational skills and ability to prioritize in a fast‑paced environment
- Excellent verbal and written communication skills
- Proficiency in Microsoft Office (Word, Excel, Outlook)
- Ability to work independently with minimal supervision
- Ability to travel to the Irvine, CA office a few times per year
Nice to Have:
- SIP certification or CA adjuster certification
- Experience working with carrier clients
- High-volume caseload experience
Bilingual (Spanish) proficiency — spoken and written — is required for this role.
Why You’ll Love Working Here
- 4 weeks (Paid time off that accrues throughout the year in accordance with company policy) + 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.
CCMSI offers comprehensive benefits including medical, dental, vision, life, and disability insurance.
Paid time off accrues throughout the year in accordance with company policy, with paid holidays and eligibility for retirement programs in accordance with plan documents.
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.
Background checks, if required for the role, are conducted only after a conditional offer and in accordance with applicable fair chance hiring laws.
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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