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Claim Representative, Medical Only

3 months ago

Des Moines, Iowa, United States Cannon Cochran Management Services, Inc. (CCMSI) Full time

At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts. Certified as a Great Place To Work, our employee satisfaction and retention ranks in the 95th percentile.

Reasons you should consider a career with CCMSI:

  • Culture: Our Core Values are embedded into our culture of how we treat our employees as a valued partner-with integrity, passion and enthusiasm.
  • Career development: CCMSI offers robust internships and internal training programs for advancement within our organization.
  • Benefits: Not only do our benefits include 4 weeks paid time off in your first year, plus 10 paid holidays, but they also include Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP.
  • Work Environment: We believe in providing an environment where employees enjoy coming to work every day, are provided the resources needed to perform their job and claims staff are assigned manageable caseloads.

This is a hybrid position after the initial training period, with a schedule of 2 days per week in the office and 3 days per week at home. Candidates must be willing and able to commute to our West Des Moines office. This position involves adjusting medical-only workers' compensation claims within Iowa and Nebraska jurisdictions. The ideal candidate will have experience with medical terminology and medical-only claims. Previous experience with workers' compensation or in a medical office is helpful.

The Medical Only Claim Representative is responsible for handling designated medical-only claims and providing support to the claim staff. This position may serve as a training role for consideration for promotion to an intermediate-level claim position. The representative 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 files only in accordance with corporate claim standards and law.
  • Establish reserves and/or provide reserve recommendations within established authority levels under minimal supervision.
  • Review and approve related medical and miscellaneous invoices on designated claims. Negotiate any disputed bills/invoices for resolution under minimal supervision.
  • Set up designated claims files and complete all set up instructions, as requested.
  • Review and maintain personal diary on claim system.
  • Request and monitor medical treatment of designated claims in accordance with corporate claim standards.
  • Return provider phone calls.
  • Summarize all correspondence and medical records in claim log notes as well as file same in the appropriate claim.
  • Close claim files when appropriate.
  • Retrieve closed claim files and re-file in storage, as requested.
  • Delivery of quality claim service to clients.
  • Client Satisfaction
  • Provide support to claim staff on client service teams.
  • Compliance with Corporate Claim Standards and special client handling instructions as established.
  • May be required to handle more sophisticated or national accounts with more stringent claim handling service instructions.
  • May be required to handle multiple jurisdictions within caseload.
  • Perform/assist with claim audits for Medical Only I and II adjusters as needed.
  • Train newly hired/promoted Medical Only adjusters.
  • Work with Medical Only I and II adjusters as needed to develop an action plan(s) to achieve any necessary improvement.
  • Special projects and in depth research as requested.
  • Technical supervision of designated claim files.
  • Work with minimal supervision and direction.
Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Excellent oral and written communication skills.
  • Individual must be a self-starter with strong organizational abilities.
  • Ability to coordinate and prioritize required.
  • Ability to operate general office equipment and perform clerical duties.
  • Flexibility, initiative, and the ability to work with a minimum of direct supervision a must.
  • Discretion and confidentiality required.
  • Ability to work as a team member in a rapidly changing environment.
  • Reliable, predictable attendance within client service hours for the performance of this position.
  • Responsive to internal and external client needs.
  • Ability to clearly communicate verbally and/or in writing both internally and externally.

Education and/or Experience

Associates degree or two year's related business experience required.

Knowledge of medical terminology preferred.

Computer Skills

Proficient with Microsoft Office programs.

Certificates, Licenses, Registrations

None required.

CORE VALUES & PRINCIPLES

Responsible for upholding the CCMSI Core Values & Principles which include: performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity; insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better; and leading by example.

CCMSI is an Affirmative Action / Equal Employment Opportunity employer offering an excellent benefit package including Medical, Dental, Prescription Drug, Vision, Flexible Spending, Life, ESOP and 401K.

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