Claim Representative, Medical Only

About the role

At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success. We don’t just process claims—we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work®, and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day.

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
• Reliable, predictable attendance during assigned business hours

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

Benefits

• 4 weeks paid time off in your first year (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