Workers' Compensation Claim Rep II (CA Claims - Remote)
About The Position
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. 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.
Requirements
- 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 Haves
- SIP certification or CA adjuster certification
- Experience working with carrier clients
- High-volume caseload experience
- Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.
Responsibilities
- 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
Benefits
- 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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
