Claim Representative, Medical Only

Ccmsi • Greenwood Village, CO

2d • Onsite

About The Position

The Medical Only Claim Representative is responsible for handling designated medical-only claims across a variety of accounts and providing support to claim staff. This position may serve as a training opportunity for advancement into an intermediate-level claims role. The individual is accountable for delivering high-quality claim services in accordance with CCMSI client expectations and corporate claim standards.

Requirements

• Associate degree or two (2) years of related business experience.
• Customer‑service oriented mindset with comfort communicating by phone.
• Strong organizational skills and ability to multitask effectively.
• Ability to work efficiently on a computer and manage detailed documentation.
• Proficiency with Microsoft Office applications including Word, Excel, and Outlook.
• Reliable, predictable attendance during assigned business hours.

Nice To Haves

• Knowledge of medical terminology.
• Prior experience in claims, insurance, or medical administrative support.
• Experience supporting a single client or program environment.
• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.

Responsibilities

• Set up and manage medical‑only claim files in accordance with corporate claim standards and applicable laws.
• Establish reserves and provide reserve recommendations within authorized levels under direct supervision.
• Review and approve medical and miscellaneous invoices on designated claims; negotiate disputed bills or invoices under supervision.
• Request and monitor medical treatment in accordance with corporate claim handling standards.
• Summarize correspondence and medical records in claim system notes and file documentation appropriately.
• Close claim files when appropriate and retrieve closed files for re‑filing as requested.
• Provide ongoing support to claim staff on client service teams.
• Communicate with medical providers, injured workers, and internal partners; frequent phone work is required.
• Ensure compliance with corporate claim handling standards and special client handling instructions.

Benefits

• 4 weeks (Paid time off that accrues throughout the year in accordance with company policy) + 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree