Claim Representative, Medical Only

Ccmsi • Albuquerque, NM

7h • Onsite

About The Position

The Medical Only Claim Representative manages medical-only workers’ compensation claims from start to finish for a multiple-client desk spanning various industries within the New Mexico jurisdiction. The role focuses on quality medical management, accurate documentation, and compliance with CCMSI standards and client handling instructions. It is an in-office position in Albuquerque, New Mexico, with a potential opportunity for a hybrid schedule in the future based on performance and business needs. It may also serve as a training and development position for advancement into higher-level claim roles.

CCMSI describes its workplace as supportive and team-based, with internal training and advancement opportunities. The role’s success is measured by timely handling of assigned claims, compliance with corporate standards and New Mexico regulations, accurate documentation, appropriate reserve activity, timely claim closure, team support, dependable attendance, and recognizing that every claim represents a real person.

Requirements

• Associate degree or two years of related business experience.
• Ability to manage medical-only claims from cradle to grave.
• Active New Mexico Adjuster License or ability to obtain one within 60 days of hire.
• Strong attention to detail and organizational skills.
• Ability to follow established procedures and meet deadlines.
• Proficiency with Microsoft Office, including Word, Excel, and Outlook.
• Strong written and verbal communication skills.
• Reliable, predictable attendance during scheduled hours.
• Ability to work in a fast-paced, in-office environment.

Nice To Haves

• Prior medical-only or workers’ compensation claims experience.
• Knowledge of medical terminology.
• Experience working with multiple clients or industries.
• Prior experience in a third-party administrator (TPA) environment.
• Bilingual Spanish proficiency, highly valued but not required.

Responsibilities

• Set up and manage medical-only workers’ compensation claim files in accordance with corporate standards and New Mexico regulations.
• Review incoming medical documentation and summarize correspondence and records in claim notes.
• Establish initial reserves and provide reserve recommendations under direct supervision.
• Review, approve, and process medical and miscellaneous invoices related to designated claims.
• Assist with bill negotiations or dispute resolution under guidance.
• Coordinate and monitor medical treatment to ensure timely and appropriate care.
• Maintain accurate, timely, and well-documented electronic claim files.
• Close claim files when appropriate and retrieve closed files as needed.
• Support claim staff and client service teams with medical-only claim activity.
• Maintain compliance with corporate claim handling standards and client-specific instructions.

Benefits

• Four weeks of paid time off, accruing throughout the year in accordance with company policy.
• 10 paid holidays in the first year.
• Medical, dental, vision, life, and disability insurance.
• 401(k) retirement plan.
• Employee Stock Ownership Plan (ESOP).
• Internal training and advancement opportunities.
• Supportive, team-based work environment.

What This Job Offers

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