Claim Representative, Medical Only

Ccmsi•Irvine, CA

14d•$23 - $25•Hybrid

About The Position

Overview Workers’ Compensation Medical Only Claim Representative Location: Irvine, CA (Hybrid after initial training period) Schedule: Monday–Friday, 8:00 AM–4:30 PM PST (37.5 hour work week) Pay Range: $23.00–$25.00 per hour (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 Medical Only Claim Representative to support a PEO/Staffing account handling California medical-only workers’ compensation claims . This role is in-office during initial training , with a hybrid schedule available afterward , reporting to our Irvine, CA branch . This position is ideal for a claims professional with an interest in workers’ compensation who enjoys medical management, organization, and accuracy. You’ll manage medical-only claims from setup through closure while partnering closely with adjusters and client teams. This role may also serve as a training ground for advancement into intermediate or full adjusting positions. Responsibilities When we hire claims professionals at CCMSI, we look for people who understand that every claim represents a real person’s livelihood, take ownership of their work, and approach each task with care, accuracy, and accountability.

Requirements

Associate degree or two years of related business, insurance, medical, or administrative experience
Strong organizational skills with the ability to manage multiple tasks and priorities
Clear written and verbal communication skills
Ability to work independently while collaborating within a team environment
Reliable, predictable attendance within established client service hours

Nice To Haves

SIP designation or interest in obtaining
Knowledge of medical terminology
Prior experience supporting workers’ compensation or medical claims
Proficiency with Microsoft Word, Excel, Outlook, and claims systems
Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.

Responsibilities

Set up and manage medical-only workers’ compensation claim files in compliance with California law and CCMSI standards
Establish reserves and provide reserve recommendations within assigned authority levels under supervision
Review and approve medical and related invoices to ensure accuracy, reasonableness, and claim-relatedness
Assist with negotiation and resolution of disputed medical bills under guidance
Request, track, and monitor medical treatment in accordance with corporate standards and client instructions
Accurately summarize medical records and correspondence within the claim system
Maintain timely diary management and documentation
Close medical-only claims when appropriate and in compliance with guidelines
Provide administrative and claim support to adjusters and client service teams
Ensure ongoing compliance with Corporate Claim Handling Standards and client-specific requirements

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

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