Claim Representative, Medical Only

Ccmsi • Reno, NV

4d • Onsite

About The Position

The Medical Only Claim Representative handles designated medical-only claims and supports claim staff. The role may serve as a training position for advancement to an intermediate-level claims position. The representative is accountable for delivering claim services that meet CCMSI client expectations and corporate claim standards. The position is based in Reno, Nevada, and is scheduled Monday through Friday from 7:30 a.m. to 4:00 p.m. Pacific Time. Frequent phone work is required, including communication with medical providers, injured workers, and internal partners.

Requirements

• Associate degree or two years of related business experience.
• Customer-service-oriented mindset and 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, and 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 document files 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

• Four weeks of paid time off, accruing throughout the year in accordance with company policy.
• Ten 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.
• The role may also qualify for bonuses or additional forms of pay.

What This Job Offers

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