California Claims Assistant

2 weeks ago

Irvine, United States CCMSI Full time
Overview

At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts. Certified as a Great Place To Work, our employee satisfaction and retention ranks in the 95th percentile.    

Reasons you should consider a career with CCMSI:

    • Culture: Our Core Values are embedded into our culture of how we treat our employees as a valued partner-with integrity, passion and enthusiasm.
    • Career development: CCMSI offers robust internships and internal training programs for advancement within our organization.
    • Benefits: Not only do our benefits include 4 weeks paid time off in your first year, plus 10 paid holidays, but they also include Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP.
    • Work Environment: We believe in providing an environment where employees enjoy coming to work every day, are provided the resources needed to perform their job and claims staff are assigned manageable caseloads.

We are seeking a dedicated and detail-oriented Claim Assistant to join our team in an in-office role, Monday through Friday, from 7:30 AM to 4:30 PM. This hourly position involves providing administrative support to a team of California Workers' Compensation Claim Adjusters.

The ideal candidate must be able to type at least 40 words per minute, have experience with MS Office—particularly Excel—, and possess excellent customer service skills. Strong written and verbal communication abilities, including professional email writing, are essential. While knowledge of medical terminology is helpful, it is not required.

In this role, you will investigate and evaluate contested medical-only claims and handle indemnity cases under close supervision. This position may also serve as a training ground for future promotion to an intermediate-level claim role. You will be accountable for delivering high-quality claim service that meets CCMSI's Corporate Claim Standards and exceeds client expectations.

This is a great opportunity for those looking to grow their career within the workers' compensation field while working in a supportive and professional office environment.

Responsibilities
  • Investigate, evaluate and adjust contested medical-only claims and handle indemnity claims under direct supervision.  
  • Establish reserves and/or provide reserve recommendations within established authority levels under direct supervision. 
  • Set up designated claim files and complete all set up instructions, as requested. 
  • Set up independent medical exams as deemed necessary under direct supervision. 
  • Request and monitor medical treatment of designated claims in accordance with corporate claim standards. 
  • Review and approve related medical, legal, damage estimates and miscellaneous invoices on designated claims. Negotiate any disputed bills/invoices for resolution under direct supervision. 
  • Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws under direct supervision, when appropriate. 
  • As appropriate, make referrals to outside vendors on designated cases under direct supervision. (i.e. legal, surveillance, case management, etc.) 
  • Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the claim adjustment process. 
  • Authorize and make payments on claims utilizing a claim payment program in accordance with industry standards and within established authority levels under direct supervision. 
  • Compute disability rates in accordance with state laws under direct supervision, when appropriate. 
  • Summarize all correspondence and medical records in claim log notes as well as file same in the appropriate claim. 
  • Return provider calls. 
  • Review and maintain personal diary on claim system. 
  • Provide technical and clerical claims support to designated clients, as requested.  
  • Compliance with corporate claim standards and special client handling instructions as established. 
  • Other duties, as assigned.
Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Excellent oral and written communication skills.
  • Individual must be a self-starter with strong organizational abilities.
  • Ability to coordinate and prioritize required.
  • Ability to operate general office equipment and perform clerical duties.
  • Flexibility, initiative, and the ability to work with a minimum of direct supervision a must.
  • Discretion and confidentiality required.
  • Ability to work as a team member in a rapidly changing environment.
  • Reliable, predictable attendance within client service hours for the performance of this position.
  • Responsive to internal and external client needs.
  • Ability to clearly communicate verbally and/or in writing both internally and externally.

Education and/or Experience    

Associate’s degree or two year’s related business experience.

Knowledge of medical terminology preferred.

Computer Skills            

Proficient with Microsoft Office programs.

Certificates, Licenses, Registrations

none required.

CORE VALUES & PRINCIPLES

Responsible for upholding the CCMSI Core Values & Principles which include: performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity; insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better; and leading by example.

CCMSI is an Affirmative Action / Equal Employment Opportunity employer offering an excellent benefit package including Medical, Dental, Prescription Drug, Vision, Flexible Spending, Life, ESOP and 401K.  

#CCMSICareers #CCMSIIrvine #EmployeeOwned #GreatPlaceToWorkCertified #ESOP #ClaimsAssistant #AdminSupport #WorkersCompensation #InOfficeJob #IrvineJobs #FullTimePosition #JobOpportunity #HiringNow #CaliforniaJobs #OfficeWork #OfficeLife #CareerGrowth #IND456

  • Workers Compensation Claims Adjuster

    4 weeks ago

    Irvine, California, United States TheBest Claims Solutions Full time

    Our client, is in need of a Temporary Workers' Compensation Claims Examiner for their Irvine Office to work on a hybrid basis. The ideal candidate will have 3+ years of California Workers Compensation Experience.Required Qualifications:3+ years of experience handling Workers' Compensation claims in California.Ability to negotiate settlement of claims within...

  • Workers Compensation Claims Adjuster

    4 weeks ago

    Irvine, United States TheBest Claims Solutions Full time

    Our client, is in need of a Temporary Workers' Compensation Claims Examiner for their Irvine Office to work on a hybrid basis. The ideal candidate will have 3+ years of California Workers Compensation Experience.Required Qualifications:3+ years of experience handling Workers' Compensation claims in California.Ability to negotiate settlement of claims...

  • California Claims Assistant

    1 week ago

    Irvine, California, United States CCMSI Full time

    About the RoleWe are seeking a highly skilled and detail-oriented Claims Assistant to join our team at CCMSI. As a Claims Assistant, you will play a critical role in providing administrative support to our team of California Workers' Compensation Claim Adjusters.Key ResponsibilitiesInvestigate and evaluate contested medical-only claims and handle indemnity...

  • California Claims Assistant

    5 days ago

    Irvine, California, United States CCMSI Full time

    About CCMSICCMSI is a leading Third Party Administrator in self-insurance services, dedicated to delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts. Our employee satisfaction and retention ranks in...

  • Workers' Compensation Claim Supervisor

    3 months ago

    Irvine, United States CCMSI Full time

    Overview: At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs,...

  • Bilingual CA Workers Compensation Claims Adjuster

    3 months ago

    Irvine, United States The Jonus Group Full time

    Job Description : Our client is expanding their Workers Compensation Department and seeking to add a Workers' Compensation Claims Adjusters to their California Operations. This person would be responsible for handling California Workers' Compensation Indemnity claims. Qualified candidates must possess a strong knowledge in California Workers'...

  • Workers' Compensation Claim Supervisor

    3 weeks ago

    Irvine, United States CCMSI Full time

    Overview At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs,...

  • Major Claims Attorney

    2 weeks ago

    Irvine, United States Fidelity National Financial Full time

    Overview Manage the disposition of Major Claims (currently $2.5M minimum exposure) from inception to final disposition; the typical caseload involves 30-40 projects some of which may involve multiple claims and/or cases. Duties • Investigation of each claim: gather relevant documents from insured and from internal operations (title and escrow); personal...

  • Claims Processing Specialist

    2 weeks ago

    Irvine, California, United States Western Growers Full time

    Become a vital part of our team as a Claims Processing Specialist at Western GrowersOverviewAssist the claims division by managing claim documentation and associated communications.RequirementsHigh school diploma or equivalent with 1-3 years of relevant experience preferred.Familiarity with healthcare eligibility protocols and HIPAA compliance.Proficient in...

  • Compensation Claims Leadership Role

    6 days ago

    Irvine, California, United States CCMSI Full time

    Job SummaryThe Workers' Compensation Claim Supervisor is a critical role within our organization, responsible for overseeing the investigation, adjustment, and supervision of assigned claims. This position requires a high level of expertise in claim handling, negotiation, and leadership.Key ResponsibilitiesClaim Oversight: Review, assign, and provide...

  • Personal Injury Claims Specialist

    6 days ago

    Irvine, California, United States Macdonald & Cody, LLP Full time

    About Macdonald & Cody, LLPWe are a reputable insurance defense litigation firm specializing in personal injury and catastrophic injury claims. Our team is dedicated to providing exceptional service to our clients and we are seeking a skilled paralegal to join our growing pre-litigation team.ResponsibilitiesPre-Litigation Settlement Analysis: Review and...

  • Food Service Worker

    2 days ago

    Irvine, California, United States University Of California Irvine Full time

    Job SummaryWe are seeking a highly motivated and detail-oriented Food Service Worker to join our team at the University of California Irvine. As a Food Service Worker, you will play a critical role in ensuring the highest quality food service experience for our students, faculty, and staff.Key ResponsibilitiesAssist with food preparation and serving in a...

  • Major Claims Attorney

    15 hours ago

    Irvine, CA, United States Fidelity National Financial Full time

    Overview Manage the disposition of Major Claims (currently $2.5M minimum exposure) from inception to final disposition; the typical caseload involves 30-40 projects some of which may involve multiple claims and/or cases. Duties • Investigation of each claim: gather relevant documents from insured and from internal operations (title and escrow);...

  • Administrative Assistant for Claims Recovery Team

    1 week ago

    Irvine, California, United States Crowell & Moring Full time

    Job OverviewCrowell & Moring LLP is a globally recognized law firm with a presence across the United States, Europe, MENA, and Asia, providing representation in litigation, arbitration, regulatory, policy, and corporate matters. The firm is well-known for its advocacy for Fortune 500 companies in complex litigation and government-related issues, alongside...

  • Claims Recovery Project Coordinator

    1 week ago

    Irvine, California, United States Crowell & Moring Full time

    Job OverviewCrowell & Moring LLP is a globally recognized law firm with a presence across the United States, Europe, MENA, and Asia, specializing in various legal areas including litigation, arbitration, regulatory affairs, and corporate transactions. The firm is well-known for its representation of Fortune 500 clients in significant legal matters and is...

  • Claims Recovery Project Coordinator

    2 weeks ago

    Irvine, California, United States Crowell & Moring Full time

    Job OverviewCrowell & Moring LLP is a globally recognized law firm with a presence across the United States, Europe, MENA, and Asia, specializing in litigation, arbitration, regulatory and policy matters, as well as transactional and corporate services. The firm is well-known for its representation of major corporations in significant legal disputes and...

  • Research Assistant

    3 days ago

    Irvine, California, United States University Of California Irvine Full time

    Job SummaryWe are seeking a highly motivated and detail-oriented Research Assistant to join our team at the University of California, Irvine. The successful candidate will assist faculty with research investigations in health services research, focusing on improving patient care adherence, shared decision-making, and health disparities.Key...

  • Healthcare Claims Specialist

    2 weeks ago

    Irvine, California, United States Agendia Full time

    COMPENSATION:Incentive opportunities ranging from $1,000 to $9,000 per quarter.OBJECTIVE OF THE ROLE:The Patient Advocate Representative is responsible for monitoring the progress of submitted claims and invoices, requesting medical documentation as necessary, and preparing various medical appeals for submission to insurance providers. This role ensures...

  • Claims Resolution Specialist

    2 weeks ago

    Irvine, California, United States Agendia Full time

    COMPENSATION:Lucrative incentive opportunity ranging from $1,000-$9,000 per quarter.OBJECTIVE OF THE ROLE:The Patient Advocate Representative is responsible for monitoring the progress of submitted claims and invoices, obtaining necessary medical records, and preparing various medical appeals for submission to insurance providers. This role ensures timely...

  • Speech Language Pathologist Assistant

    3 days ago

    Irvine, California, United States Soliant Full time

    Job Summary:Soliant Therapy is seeking a highly skilled Speech Language Pathologist Assistant to join our team in a school district in California. As an SLPA, you will work closely with our team to provide high-quality speech therapy services to students in a K-12 setting.Responsibilities:Provide speech therapy services to students in a K-12 settingWork...