Claim Representative, Medical Only

Ccmsi • Metairie, LA

5d • Onsite

About The Position

The Medical Only Claim Representative is responsible for the handling of designated workers’ compensation medical-only claims and providing support to claim staff across multiple accounts. This role manages a high-volume caseload of primarily low-complexity claims, including basic medical-only claims, subrogation opportunities, Second Injury Fund (SIF) considerations, and ongoing medical management on older claims. This position serves as a foundational development role, offering training and growth into intermediate-level adjuster positions. The role requires strong organization, attention to detail, and the ability to communicate effectively with claimants, medical providers, and internal teams while delivering accurate, compliant, and timely claim outcomes.

Requirements

• Active Louisiana Adjuster License or the ability to obtain within first 60 days of employment
• Associate Degree or minimum of two (2) years of related business, insurance, or administrative experience
• Basic understanding of workers’ compensation and willingness to develop technical claim knowledge
• Strong customer service skills with comfort handling phone-based communication
• Excellent organizational, time management, and prioritization skills
• Ability to manage a high-volume caseload with accuracy and efficiency
• Strong written and verbal communication skills
• Proficiency with Microsoft Office applications (Word, Excel, 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