Workers’ Compensation Claim Rep I (CA Expertise Required)
CCMSI is a global leader in risk management solutions, seeking a Workers’ Compensation Claim Representative I to handle California workers’ compensation claims. The role involves investigating claims, managing medical and legal activities, and ensuring compliance with regulations while providing excellent service to clients.
Responsibilities
- 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
Skills
- 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
- 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
Benefits
- 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
Company Overview