Medical Claims Assistant

4 days ago

Dallas, Texas, United States CCMSI Full time
Overview

At CCMSI, we are committed to delivering exceptional service to our clients. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients.

We are seeking a detail-oriented and organized Claim Assistant to join our Dallas office on an hourly basis. This in-office role is essential to supporting our claims team, particularly in managing medical-only workers' compensation claims.

Responsibilities
  • Investigate, evaluate and adjust contested medical-only claims and handle indemnity claims under direct supervision.
  • Establish reserves and/or provide reserve recommendations within established authority levels under direct supervision.
  • Set up designated claim files and complete all set up instructions, as requested.
  • Set up independent medical exams as deemed necessary under direct supervision.
  • Request and monitor medical treatment of designated claims in accordance with corporate claim standards.
  • Review and approve related medical, legal, damage estimates and miscellaneous invoices on designated claims. Negotiate any disputed bills/invoices for resolution under direct supervision.
  • Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws under direct supervision, when appropriate.
  • As appropriate, make referrals to outside vendors on designated cases under direct supervision. (i.e. legal, surveillance, case management, etc.)
  • Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the claim adjustment process.
  • Authorize and make payments on claims utilizing a claim payment program in accordance with industry standards and within established authority levels under direct supervision.
  • Compute disability rates in accordance with state laws under direct supervision, when appropriate.
  • Summarize all correspondence and medical records in claim log notes as well as file same in the appropriate claim.
  • Return provider calls.
  • Review and maintain personal diary on claim system.
  • Provide technical and clerical claims support to designated clients, as requested.
  • Compliance with corporate claim standards and special client handling instructions as established.
  • Other duties, as assigned.
Qualifications
  • 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 years related business experience.

Knowledge of medical terminology preferred.

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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