Claim Representative, Medical Only Senior

Ccmsi • Phoenix, AZ

5d • Hybrid

About The Position

Manages designated medical-only claims and provides support to claims staff. Serves as a developmental role with potential advancement to an intermediate claims position. Responsible for delivering high-quality claim service in alignment with CCMSI client expectations and corporate claim standards.

Requirements

• Strong oral and written communication skills
• Arizona Adjuster License
• ICA Arizona Adjuster Authorization
• 5 or more years handling medical only claims
• Self-motivated with the ability to work independently and take initiative
• Excellent organizational, coordination, and prioritization skills
• Ability to operate general office equipment and perform clerical tasks
• Demonstrated flexibility and adaptability in a fast-paced, changing environment
• Ability to work effectively with minimal direct supervision
• High level of discretion with the ability to maintain confidentiality
• Strong teamwork and collaboration skills
• Reliable and consistent attendance within designated client service hours
• Commitment to delivering responsive, high-quality service to internal and external clients
• Ability to communicate clearly and professionally, both verbally and in writing, with all stakeholders

Nice To Haves

• Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, or vendors.
• Experience supporting municipal accounts is a plus
• Knowledge of medical terminology
• Prior experience in a claims or medical

Responsibilities

• Manage and administer designated medical-only claims in compliance with corporate claim standards and applicable laws
• Establish and maintain appropriate reserves within authority limits or provide reserve recommendations
• Review, approve, and negotiate medical and related invoices to ensure accurate and timely payment resolution
• Set up new claim files and ensure all required documentation and system entries are completed accurately
• Maintain claim activity through detailed diary management and timely follow-up
• Coordinate, request, and monitor medical treatment in accordance with established guidelines
• Respond promptly to provider and stakeholder inquiries, including return phone calls
• Document and summarize correspondence, medical records, and claim activity in file notes and maintain organized claim files
• Close claims appropriately and assist with file retrieval and storage as needed
• Deliver high-quality claim service aligned with client expectations and corporate standards
• Adhere to all corporate claim procedures and specialized client handling instructions
• Support client service teams and contribute to overall client satisfaction
• Provide support and technical guidance to claim staff
• Assist with claim audits and quality reviews for Medical Only I and II adjusters
• Train and mentor newly hired or promoted adjusters
• Partner with team members to develop and implement performance improvement plans as needed
• Handle more complex claims, including national accounts, as assigned
• Manage claims across multiple jurisdictions when required
• Participate in special projects and conduct in-depth research as requested
• Exercise technical oversight of designated claim files
• Work independently with minimal supervision while maintaining high performance standards

Benefits

• 4 weeks (Paid time off that accrues throughout the year in accordance with company policy) + 10 paid holidays in your first year
• Medical, Dental, Vision, Life, and Disability Insurance
• 401(k) and Employee Stock Ownership Plan (ESOP)
• Internal training and advancement opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed