Claim Representative, Medical Only
About The Position
CCMSI is Hiring! We’re looking for a Workers' Compensation Claim Adjuster, Medical Only to join our team. This role is hybrid , reporting to our Maitland, FL office. At CCMSI, we are employee-owned and committed to providing exceptional service. We offer manageable caseloads, extensive career development, and industry-leading benefits. 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
- Associate Degree or two (2) year's related business experience required
- Proficient using Microsoft Office products such as Word, Excel, Outlook
Nice To Haves
- Knowledge of medical terminology preferred.
- Jurisdictions Preferred: Fl, GA, SC, NC, WV, VA
- Adjusters license may be required based upon jurisdiction.
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.
Benefits
- Work-Life Balance – Enjoy 4 weeks of PTO in your first year + 10 paid holidays
- Comprehensive Benefits – Medical, Dental, Vision, 401K, ESOP & more
- Career Growth – Structured training programs with opportunities for advancement
- Supportive Culture – Work in an environment where your expertise is valued
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
Number of Employees
1,001-5,000 employees
