Medical Only Claim Rep (TX) - Hybrid/Remote

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. The Medical Only Claim Representative is responsible for claims handling of designated medical only claims and provide support to claim staff. This position may be used 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. Located in Dallas, TX (Hybrid or Remote Opportunity). 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. Our Core Values: Doing What’s Right—for Our Clients, Our Coworkers, And Ourselves. We Look For Team Members Who Lead with transparency, Perform with integrity, Chase excellence, Own the outcome, Win together.

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