Medical Claims Adjuster

2 weeks ago

Dallas, Texas, United States CCMSI Full time
Overview

At 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 recognizing individual and team efforts. Certified as a Great Place To Work, our employee satisfaction and retention ranks in the 95th percentile.

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.
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.

  • 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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