Medical Claims Adjuster

4 days 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 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.

As a Medical-Only Claims Adjuster, you will be responsible for setting up and managing medical files only in accordance with corporate claim standards and law. You will establish reserves and/or provide reserve recommendations within established authority levels under direct supervision. You will review and approve related medical and miscellaneous invoices on designated claims. You will negotiate any disputed bills/invoices for resolution under direct supervision. You will request and monitor medical treatment of designated claims in accordance with corporate claim standards. You will summarize all correspondence and medical records in claim log notes as well as file same in the appropriate claim. You will close claim files when appropriate. You will retrieve closed claim files and re-file in storage, as requested. You will provide support to claim staff on client service teams. You will comply with Corporate Claim Standards and special client handling instructions as established. You will perform other duties as assigned.

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.

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.

CCMSI is 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.

Our Core Values are embedded into our culture of how we treat our employees as a valued partner-with integrity, passion and enthusiasm. 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.



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