Workers Compensation Claim Rep II (CA Expertise Required)

Workers' Compensation Claim Representative II

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.

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.

• 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

Qualifications

What You'll Bring

Required

510 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

Why You'll Love Working Here

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 rightfor our clients, our coworkers, and ourselves. We look for team members who :

We don't just work togetherwe grow together. If that sounds like your kind of workplace, we'd love to meet you.