Claim Representative, Medical Only - In Office

Location: Metairie, LA (Onsite)

About the role

The Medical Only Claim Representative is responsible for handling designated workers’ compensation medical-only claims and providing support to claim staff across multiple accounts. This role manages a high-volume caseload of primarily low-complexity claims, including basic medical-only claims, subrogation opportunities, Second Injury Fund (SIF) considerations, and ongoing medical management on older claims. This position serves as a foundational development role, offering training and growth into intermediate-level adjuster positions.

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

At CCMSI, we look for detail-oriented professionals who understand that every task supports a real person’s claim experience, value accuracy and responsiveness, and contribute to the team’s success through organization, collaboration, and a strong commitment to service.

Requirements

• Active Louisiana Adjuster License or the ability to obtain within first 60 days of employment
• Associate Degree or minimum of two (2) years of related business, insurance, or administrative experience
• Basic understanding of workers’ compensation and willingness to develop technical claim knowledge
• Strong customer service skills with comfort handling phone-based communication
• Excellent organizational, time management, and prioritization skills
• Ability to manage a high-volume caseload with accuracy and efficiency
• Strong written and verbal communication skills
• Proficiency with Microsoft Office applications (Word, Excel, 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 of paid time off that accrues throughout the year in accordance with company policy, plus 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
• Supportive, team-based work environment

Pay

Salary Range: $40,000 annually ($20.51/hour)

Schedule

Monday–Friday, 8:00 AM – 4:30 PM

How We Measure Success

At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by:

• Quality claim handling – thorough investigations, strong documentation, well-supported decisions
• Compliance & audit performance – adherence to jurisdictional and client standards
• Timeliness & accuracy – purposeful file movement and dependable execution
• Client partnership – proactive communication and strong follow-through
• Professional judgment – owning outcomes and solving problems with integrity
• Cultural alignment – believing every claim represents a real person and acting accordingly

Core Values

• 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.