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Claim Assistant

2 months ago

Trenton, New Jersey, United States CCMSI Full time
Job Summary

We are seeking a highly skilled and detail-oriented Claim Assistant to join our team at CCMSI. As a Claim Assistant, you will be responsible for investigating and evaluating contested medical-only claims, handling indemnity cases under close supervision, and ensuring the quality of claim service as perceived by our clients and within Corporate Claim Standards.

Key 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 setup 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 with Corporate Claim Standards, client-specific handling instructions, and state laws under direct supervision, when appropriate.
  • Make referrals to outside vendors on designated cases under direct supervision (i.e., legal, surveillance, case management, etc.).
  • Effectively and timely coordinate 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.
Requirements
  • 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 Experience

Associate's degree or two years of related business experience. Knowledge of medical terminology preferred.

Certificates, Licenses, Registrations

Must pass Texas Adjuster license as requested.

CORE VALUES & PRINCIPLES

Responsible for upholding the CCMSI Core Values & Principles which include: performing with integrity; passionately focusing 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.