Claim Representative, Medical Only

Medical Only Claim Representative

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.

The Medical Only Claim Representative is responsible for claims handling of designated medical only claims and provide support to claim staff. This position may be used as a training position for consideration of promotion to an intermediate level claim position. Is accountable for the quality of claim services as perceived by CCMSI clients and within the corporate claim standards.

Responsibilities

Set up and manage medical files only in accordance with corporate claim standards and law.

Establish reserves and/or provide reserve recommendations within established authority levels under direct supervision.

Review and approve related medical and miscellaneous invoices on designated claims. Negotiate any disputed bills/invoices for resolution under direct supervision.

Request and monitor medical treatment of designated claims in accordance with corporate claim standards.

Summarize all correspondence and medical records in claim log notes as well as file same in the appropriate claim.

Close claim files when appropriate.

Retrieve closed claim files and re-file in storage, as requested.

Provide support to claim staff on client service teams.

Compliance with Corporate Claim Standards and special client handling instructions as established.

Performs 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.

Associate Degree or two (2) year's related business experience required

Knowledge of medical terminology preferred.

Proficient using Microsoft Office products such as Word, Excel, Outlook

Adjusters license may be required based upon jurisdiction.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Work requires the ability to stoop, bend, reach and grab with arms and hands, manual dexterity

Work requires the ability to sit or stand up to 7.5 or more hours at a time

Work requires sufficient auditory and visual acuity to interact with others

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 included Medical, Dental, Vision, Prescription Drug, Flexible Spending, Life, ESOP, and 401K.

Compensation & Compliance

The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.

CCMSI offers a comprehensive benefits package, which will be reviewed during the hiring process. Please contact our hiring team with any questions about compensation or benefits.

CCMSI does not provide visa sponsorship for this position.

CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. If you need assistance or accommodation, please contact our team.

CCMSI is an Affirmative Action / Equal Employment Opportunity employer. We comply with all applicable employment laws, including pay transparency and fair chance hiring regulations. Background checks are conducted only after a conditional offer of employment.