Arizona Medical Only Work Comp Adjuster (ICA|TPA)

Ccmsi•Scottsdale, AZ

1d•Hybrid

About The Position

The Medical Only Claim Representative handles designated medical-only claims and provides support to claim staff. The position may serve as a training role for consideration of promotion to an intermediate-level claim position. The representative is accountable for delivering quality claim services in accordance with client expectations and CCMSI corporate claim standards. The role is based in Scottsdale, Arizona, with a schedule of 8:00 a.m. to 4:30 p.m. Mountain Standard Time and a hybrid arrangement after initial training. Frequent phone communication is required.

Requirements

Associate degree or two years of related business experience.
Arizona ICA required.
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.
10 paid holidays in the first year.
Medical insurance.
Dental insurance.
Vision insurance.
Life insurance.
Disability insurance.
401(k) retirement plan.
Employee Stock Ownership Plan (ESOP).
Internal training and advancement opportunities.
Supportive, team-based work environment.