CCMSI · 1 day ago
Workers’ Compensation Claim Rep II (CA Expertise Required)
San Diego County, CA
Full-time
Hybrid
Mid, Senior Level
$70K/yr - $80K/yr
5+ years expCCMSI is a leading Third Party Administrator that partners with global clients to address complex risk management challenges. They are seeking a Workers’ Compensation Claim Representative II to manage California workers’ compensation claims from intake through resolution, ensuring compliance with regulatory standards and delivering high-quality claim service.
Financial ServicesInsuranceRetail
No H1B
Responsibilities
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
Qualification
Required
5–10 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
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
CCMSI
CCMSI is a third-party administrator for workers' compensation and property/casualty self-insurance programs.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
G
G. Bryan G. Bryan Thomas
President/CEO
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