Workers’ Compensation Claim Representative II

Overview Workers' Compensation Claim Representative II Location: Irvine, CA - reporting remotely Schedule: 8:00am - 4:30pm (PST) Salary Range: $60,000 - $80,000 (depending 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 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 a 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. Responsibilities When we hire Workers’ Compensation Adjusters at CCMSI, we look for detail‑driven problem‑solvers who balance empathy with sound judgment, navigate complex regulations with confidence, and deliver fair, timely outcomes that support injured workers and strengthen client trust. 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 Required Qualifications …