Claim Representative, Medical Only

3 weeks ago

Dallas, United States CCMSI Full time

Overview:

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.

We are seeking a skilled Medical-Only Claims Adjuster to join our Dallas office, with the option for hybrid work arrangements depending on your location. The ideal candidate must have a strong background in managing medical-only workers' compensation claims, particularly in Texas, and possess experience with school districts and/or public entities. A thorough understanding of the unique aspects of these claims is essential.

In this role, you will be responsible for investigating, managing, and resolving medical-only claims while ensuring compliance with Texas workers' compensation regulations. Your duties will include coordinating medical treatment, managing medical costs, and maintaining accurate and detailed claim records. You will work closely with claimants, medical providers, and school district or public entity representatives to ensure timely and effective claim resolution.

The position is Monday through Friday, 8 am to 4:30 pm, with flexibility for hybrid work arrangements after initial training period. If you have experience in handling medical-only claims and are looking for a role that offers both challenge and flexibility, we encourage you to apply. Join us in delivering exceptional service and support to our clients in the education and public sectors.

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 direct supervision.
  • Review and approve related medical and miscellaneous invoices on designated claims. Negotiate any disputed bills/invoices for resolution under direct supervision.
  • Request and monitor medical treatment of designated claims in accordance with corporate claim standards.
  • 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.
  • Provide support to claim staff on client service teams.
  • Compliance with Corporate Claim Standards and special client handling instructions as established.
  • Performs other duties as assigned.


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.

Education and/or Experience

Associate Degree or two (2) year's related business experience required

Knowledge of medical terminology preferred.

Computer Skills

Proficient using Microsoft Office products such as Word, Excel, Outlook

Certificates, Licenses, Registrations

Adjusters license is preferred, but not 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 included Medical, Dental, Vision, Prescription Drug, Flexible Spending, Life, ESOP and 401K.

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