Claim Representative, Medical Only
About The Position
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. 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.
Requirements
- 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 preferred.
- Knowledge of medical terminology preferred.
- Proficient using Microsoft Office products such as Word, Excel, Outlook
- Adjusters license may be required based upon jurisdiction.
Nice To Haves
- Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.
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.
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
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
