Claim Representative, Medical Only

Overview

Claim Representative, Medical Only
Location: Danville, IL
Schedule: In Office for training and eligible for hybrid
Salary Range: $19.00/hr-$21.00/hr

Job Summary

The Medical Only Claim Representative is responsible for claims handling of designated medical only claims and provides support to claim staff. This position may serve 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.

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

Qualifications

• Associate Degree or two (2) years of related business experience
• Customer-service oriented mindset with 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
• Nice To Have: 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.

Why You’ll Love Working Here

• 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

Compensation & Compliance

The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.

Background Checks, ADA Accommodations, Equal Opportunity Employer

Background checks, if required for the role, are conducted only after a conditional offer and in accordance with applicable fair chance hiring regulations. Our Core Values At CCMSI, We Believe In Doing What’s Right—for Our Clients, Our Coworkers, And Ourselves. We Look For Team Members Who Lead with transparency We build trust by being open and listening intently in every interaction. Perform with integrity We choose the right path, even when it is hard. Chase excellence We set the bar high and measure our success. What gets measured gets done. Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own. Win together Our greatest victories come when our clients succeed. We don’t just work together—we grow together.