[Hiring] Workers' Compensation Claim Representative II @CCMSI

Role Description

We are seeking an experienced and motivated California Workers’ Compensation Claim Representative II to manage a diverse portfolio of claims with professionalism, empathy, and strong technical skill. You will take ownership of various accounts. With 5–10 years of experience, you’ll bring seasoned judgment to claim investigations, compensability decisions, and timely resolution strategies. This role provides an excellent opportunity to deepen your expertise and serves as a developmental step toward more senior claim positions. As a Claim Representative II, you’ll play a key role in delivering an exceptional client experience and upholding CCMSI’s high standards for quality claim service.

• Investigate and adjust workers compensation claims in accordance with established claims handling procedures using CCMSI guidelines and direct supervision.
• Perform TD/PD/AWW calculations to ensure accurate indemnity payments in accordance with applicable workers’ compensation laws and guidelines.
• Review medical, legal and miscellaneous invoices to determine if reasonable and related to the ongoing workers compensation claims. Negotiate any disputed bills for resolution.
• Authorize and make payment of workers compensation claims utilizing a claim payment program in accordance with industry standards and within settlement authority.
• Negotiate settlements with claimants and attorneys in accordance with client's authorization.
• Assist in selection and supervision of defense attorneys.
• Assess and monitor subrogation claims for resolution.
• Prepare reports detailing claims, payments and reserves.
• Provide reports and monitor files, as required by excess insurers.
• Compliance with Service Commitments as established by team.
• Delivery of quality claim service to clients.

Qualifications

• Self-starter with strong organizational skills and the ability to work with minimal supervision.
• Proven ability to coordinate, prioritize, and manage multiple responsibilities.
• Flexibility, initiative, and adaptability in a fast-paced, rapidly changing environment.
• Strong discretion and ability to maintain confidentiality.
• Ability to work effectively as part of a team.
• Reliable, predictable attendance within client service hours.
• Responsiveness to internal and external client needs.
• Ability to communicate clearly and professionally, both verbally and in writing.
• 5 to 10 years of California Workers’ Compensation claims management experience or equivalent combination of experience and education.
• Proficiency with Microsoft Office programs (Word, Excel, Outlook, etc.).
• California Adjuster’s license is required - SIP is required.

Requirements

• Associate degree is preferred but not required.
• Experience handling liens and subrogation matters is highly preferred, though not required.
• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.

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.