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