Senior CA Workers’ Comp Claims Specialist (Remote)

CCMSI; Irvine (CA); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

4 weeks PTO + 10 holidays

Job summary

CCMSI seeks a California Workers’ Compensation Claim Representative II to manage a diversified claim portfolio with expertise and empathy. With 5–10 years of relevant experience, you’ll handle investigations, compensability decisions, and timely resolutions while upholding CCMSI’s high standards for service.

The role requires strong organizational skills, effective communication, and proficiency with Microsoft Office.

Qualifications

• 5 to 10 years of California Workers’ Compensation claims management experience.
• Proficiency with Microsoft Office programs (Word, Excel, Outlook).
• California Adjuster’s license is required - SIP is required.

Responsibilities

• Investigate and adjust workers' compensation claims following CCMSI guidelines.
• Perform TD/PD/AWW calculations to ensure accurate indemnity payments.
• Review and negotiate medical and legal invoices related to claims.
• Authorize and disburse payments within settlement authority.
• Negotiate settlements with claimants and attorneys.
• 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 for excess insurers as required.
• Ensure compliance with service commitments and deliver quality service.

Skills

Strong organizational skills

Multi-tasking

Effective communication

Team collaboration

Discretion & confidentiality

Customer service mindset

Time management

Education

Associate degree preferred

Tools

Microsoft Office (Word, Excel, Outlook)

California Adjuster’s license (SIP)

Job description

CCMSI seeks a California Workers’ Compensation Claim Representative II to manage a diversified claim portfolio with expertise and empathy. With 5–10 years of relevant experience, you’ll handle investigations, compensability decisions, and timely resolutions while upholding CCMSI’s high standards for service.

The role requires strong organizational skills, effective communication, and proficiency with Microsoft Office.