Claim Representative, Medical Only Senior

Overview

Claim Representative, Medical Only Senior
Location: Phoenix, AZ
Schedule: 8:00am - 4:30pm (MST) Hybrid schedule after initial training period (one day a week in-office)
Salary Range: $50,000 - $65,000 (depending on experience, paid out hourly)

Job Summary

Manages designated medical-only claims and provides support to claims staff. Serves as a developmental role with potential advancement to an intermediate claims position. Responsible for delivering high-quality claim service in alignment with CCMSI client expectations and corporate claim standards.

Responsibilities

• Manage and administer designated medical-only claims in compliance with corporate claim standards and applicable laws
• Establish and maintain appropriate reserves within authority limits or provide reserve recommendations
• Review, approve, and negotiate medical and related invoices to ensure accurate and timely payment resolution
• Set up new claim files and ensure all required documentation and system entries are completed accurately
• Maintain claim activity through detailed diary management and timely follow-up
• Cooky/Navigation/Legal/EEO/Equal-opportunity/scam-warning boilerplate removed

Qualifications

• Strong oral and written communication skills
• AZ Adjuster License ICA
• 5 or more years handling medical only claims
• Self-motivated with the ability to work independently and take initiative
• Excellent organizational, coordination, and prioritization skills
• Ability to operate general office equipment and perform clerical tasks
• Demonstrated flexibility and adaptability in a fast-paced, changing environment
• High level of discretion with the ability to maintain confidentiality
• Strong teamwork and collaboration skills
• Reliable and consistent attendance within designated client service hours
• Commitment to delivering responsive, high-quality service to internal and external clients
• Ability to communicate clearly and professionally, both verbally and in writing, with all stakeholders
• Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, or vendors
• Experience supporting municipal accounts is a plus
• Knowledge of medical terminology
• Prior experience in a claims or medical field

Nice to Have

• Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, or vendors
• Experience supporting municipal accounts is a plus
• Knowledge of medical terminology
• Prior experience in a claims or medical field

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.

ADA Accommodations

CCMSI is committed to providing reasonable accommodations throughout the application and hiring process.

Background checks

If required for the role, are conducted only after a conditional offer and in accordance with applicable fair chance hiring laws.

Our Core Values

• We believe in doing what’s right for our clients, coworkers, and ourselves.
• We lead with transparency.
• We build trust by being open and listening intently in every interaction.
• We perform with integrity.
• We choose the right path, even when it is hard.
• We chase excellence.
• We what gets measured gets done.
• We own the outcome.
• We win together.