Medical Claims Assistant

1 month 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.

  • Claims Assistant

    3 weeks ago

    Dallas, Texas, United States Lantern Care Full time

    About Lantern CareLantern Care is a specialty care platform that connects people with the best care when they need it most. Our mission is to deliver excellent care with significant cost savings to employers and their workforces.We achieve this by curating a Network of Excellence comprised of the nation's top specialists for surgery, cancer care, infusions,...

  • Medical Claims Specialist

    3 weeks ago

    Dallas, Texas, United States UT Southwestern Medical Center Full time

    Why UT Southwestern?As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees.Ranked as the number 1 hospital in Dallas-Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals.Our...

  • Medical Claims Adjuster

    2 weeks ago

    Dallas, Texas, United States CCMSI Full time

    Overview:At CCMSI, 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...

  • Medical Claims Adjuster

    3 weeks ago

    Dallas, Texas, United States CCMSI Full time

    OverviewAt CCMSI, we strive to deliver exceptional service to our clients in the education and public sectors. 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 focus on developing our staff through structured career development programs, rewarding and...

  • Medical Claims Specialist

    2 weeks ago

    Dallas, Texas, United States Methodist Health System Full time

    Job Summary:As a Medical Claims Specialist at Methodist Health System, you will play a vital role in managing the organization's third-party payer appeals. Your primary responsibility will be to analyze, research, and successfully appeal third-party claims within timely filing timelines. You will also provide excellent customer service, write Appeal and...

  • Senior Medical Claims Specialist

    2 weeks ago

    Dallas, Texas, United States AIG Full time

    Job Summary:AIG is seeking a highly skilled Senior Medical Claims Processor to join our team. As a Senior Claims Management Analyst, you will be responsible for overseeing claim-specific TPA activities, reviewing and analyzing TPA claim financials, and completing independent analyses to evaluate claim exposure.Key Responsibilities:Oversee claim-specific TPA...

  • Medical Claims and Collections Specialist

    3 weeks ago

    Dallas, Texas, United States Randstad Full time

    Job SummaryWe are seeking a highly skilled Medical Claims and Collections Specialist to join our team at Randstad. As a key member of our healthcare team, you will be responsible for managing outstanding receivables, preparing and submitting medical claims, and resolving billing issues.Key ResponsibilitiesManage outstanding receivables, ensuring prompt...

  • Medical Claims Specialist

    2 weeks ago

    Dallas, Texas, United States Parkland Health and Hospital System (PHHS) Full time

    Job SummaryParkland Health and Hospital System (PHHS) seeks a skilled Medical Claims Specialist to join our team. As a key member of our revenue cycle team, you will be responsible for resolving outstanding balances and securing accurate and timely payments from third-party payors.Key ResponsibilitiesResolve outstanding claims for assigned accounts by...

  • Medical Claims Adjuster

    3 weeks ago

    Dallas, Texas, United States CCMSI Full time

    Job Summary: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...

  • Claims Specialist

    3 weeks ago

    Dallas, Texas, United States Chubb Full time

    Job Title: Claims SpecialistAs a Claims Specialist at Chubb, you will be responsible for investigating and settling claims promptly and equitably. You will work under the direction of the Claims Team Leader to ensure that claims are handled in accordance with established best practices guidelines.Key Responsibilities:Investigate and settle claims in a timely...

  • Workers' Compensation Medical Only Claim Examiner

    2 weeks ago

    Dallas, Texas, United States Chubb Full time

    Job DescriptionChubb is seeking a Workers' Compensation Medical Only Claim Examiner for our Central Region. This role involves managing all aspects of Medical Only claims arising from various states, including Illinois, Iowa, Michigan, Minnesota, and Texas.Key ResponsibilitiesHandles all aspects of workers' compensation medical only claims from set-up to...

  • Workers' Compensation Medical Only Claim Examiner

    3 weeks ago

    Dallas, Texas, United States Chubb Full time

    Job Summary Chubb is seeking a Workers' Compensation Medical Only Claim Examiner to manage all aspects of Medical Only claims arising from various states. This position offers a hybrid work schedule with a minimum of 3 days per week working from either our Dallas or Chicago Office. Key ResponsibilitiesHandles all aspects of workers' compensation medical only...

  • Claims Advocate

    2 weeks ago

    Dallas, Texas, United States Alliant Insurance Services Full time

    We are seeking a highly skilled Claims Advocate to join our team at Alliant Insurance Services. In this role, you will be responsible for providing exceptional customer service and supporting Producers by servicing existing accounts and soliciting new business.As a Claims Advocate, you will act as an advocate and claims specialist to provide support to...

  • Claims Manager

    2 weeks ago

    Dallas, Texas, United States American International Group Full time

    Job SummaryAmerican International Group is seeking a skilled Claims Manager to lead our Claims team in delivering exceptional service to our clients. As a Claims Manager, you will be responsible for formulating strategies to effectively drive claims to optimal resolution, managing a team of claims adjusters, and ensuring compliance with Best Practices and...

  • Senior Claim Executive

    2 weeks ago

    Dallas, Texas, United States IMA Financial Group Full time

    Claims Resolution SpecialistIMA Financial Group is seeking a Claims Resolution Specialist to join our team. This role is responsible for advocating for and interacting with clients on claim resolutions and matters.A successful applicant must have strong relationship building and management skills, possess self-direction, and have effective problem-solving...

  • Claims Examiner III

    2 weeks ago

    Dallas, Texas, United States AmTrust Financial Full time

    Job Summary:The Commercial Auto Claims Adjuster III role at AmTrust Financial Services involves examining, investigating, and settling or declining insurance claims in a prompt and efficient manner. This position requires effective research, negotiation, and interaction with insureds and claimants to ensure cost-effective utilization of company resources.Key...

  • Claims Recovery Specialist

    4 weeks ago

    Dallas, Texas, United States Della Infotech Full time

    Job Title: Claims Recovery CollectorWe are seeking a highly skilled Claims Recovery Collector to join our team at Della Infotech. As a Claims Recovery Collector, you will be responsible for reviewing and analyzing delinquent accounts receivable, identifying outstanding insurance claims, and determining appropriate action steps for recovery.Key...

  • Data Analyst

    3 weeks ago

    Dallas, Texas, United States Lorven Technologies Full time

    Job Title: Data Analyst - Medical Claims ExpertWe are seeking a highly skilled Data Analyst to join our team at Lorven Technologies. As a Data Analyst, you will play a critical role in developing and implementing data models, creating automated data pipelines, and leading the development of production-ready data solutions.Key Responsibilities:Develop and...

  • Claims Recovery Specialist

    2 weeks ago

    Dallas, Texas, United States Della Infotech Full time

    Job SummaryWe are seeking a highly skilled Claims Recovery Specialist to join our team at Della Infotech. The successful candidate will be responsible for reviewing and analyzing delinquent accounts receivable, identifying outstanding insurance claims, and determining appropriate action steps for recovery.Key ResponsibilitiesClaim Review and Analysis: Review...

  • Claims Recovery Specialist

    3 weeks ago

    Dallas, Texas, United States Della Infotech Full time

    Job Title: Claims Recovery CollectorWe are seeking a highly skilled Claims Recovery Collector to join our team at Della Infotech. As a Claims Recovery Collector, you will be responsible for reviewing and analyzing delinquent accounts receivable, identifying outstanding insurance claims, and determining appropriate action steps for recovery.Key...