Claim Representative, Medical Only

Overview

Workers’ Compensation Medical Only Claim Representative

Location: Irvine, CA (Hybrid after initial training period)Schedule: Monday–Friday, 8:00 AM–4:30 PM PST (37.5 hour work week)Pay Range: $23.00–$25.00 per hour (dependent 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 a Workers’ Compensation Medical Only Claim Representative to support a PEO/Staffing account handling California medical-only workers’ compensation claims. This role is in-office during initial training, with a hybrid schedule available afterward, reporting to our Irvine, CA branch.

 

This position is ideal for a claims professional with an interest in workers’ compensation who enjoys medical management, organization, and accuracy. You’ll manage medical-only claims from setup through closure while partnering closely with adjusters and client teams. This role may also serve as a training ground for advancement into intermediate or full adjusting positions.

 

Responsibilities

 

When we hire claims professionals at CCMSI, we look for people who understand that every claim represents a real person’s livelihood, take ownership of their work, and approach each task with care, accuracy, and accountability.

• Set up and manage medical-only workers’ compensation claim files in compliance with California law and CCMSI standards

• Establish reserves and provide reserve recommendations within assigned authority levels under supervision

• Review and approve medical and related invoices to ensure accuracy, reasonableness, and claim-relatedness

• Assist with negotiation and resolution of disputed medical bills under guidance

• Request, track, and monitor medical treatment in accordance with corporate standards and client instructions

• Accurately summarize medical records and correspondence within the claim system

• Maintain timely diary management and documentation

• Close medical-only claims when appropriate and in compliance with guidelines

• Provide administrative and claim support to adjusters and client service teams

• Ensure ongoing compliance with Corporate Claim Handling Standards and client-specific requirements

 

Qualifications

 

Required

• Associate degree or two years of related business, insurance, medical, or administrative experience

• Strong organizational skills with the ability to manage multiple tasks and priorities

• Clear written and verbal communication skills

• Ability to work independently while collaborating within a team environment

• Reliable, predictable attendance within established client service hours

Preferred

• SIP designation or interest in obtaining

• Knowledge of medical terminology

• Prior experience supporting workers’ compensation or medical claims

• Proficiency with Microsoft Word, Excel, Outlook, and claims systems

• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.

Why You’ll Love Working Here

 

• 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

How We Measure Success 

 

At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by: