Claim Representative, Medical Only

Workers' Compensation Claim Adjuster, Medical Only

We're looking for a Workers' Compensation Claim Adjuster, Medical Only to join our team. This role is hybrid, reporting to our Maitland, FL office.

At CCMSI, we are employee-owned and committed to providing exceptional service. We offer manageable caseloads, extensive career development, and industry-leading benefits.

Why Join CCMSI?

Work-Life Balance Enjoy 4 weeks of PTO in your first year + 10 paid holidays

Comprehensive Benefits Medical, Dental, Vision, 401K, ESOP & more

Career Growth Structured training programs with opportunities for advancement

Supportive Culture Work in an environment where your expertise is valued

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.
• Performs other duties as assigned.

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.

Jurisdictions Preferred : FL, GA, SC, NC, WV, VA

Proficient using Microsoft Office products such as Word, Excel, Outlook

Adjusters license may be required based upon jurisdiction.

Work requires the ability to stoop, bend, reach and grab with arms and hands, manual dexterity

Work requires the ability to sit or stand up to 7.5 or more hours at a time

Work requires sufficient auditory and visual acuity to interact with others

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.

Compensation & Compliance

The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.

CCMSI offers a comprehensive benefits package, which will be reviewed during the hiring process. Please contact our hiring team with any questions about compensation or benefits.

CCMSI does not provide visa sponsorship for this position.

CCMSI is committed to providing reasonable accommodations throughout the application and hiring process.

CCMSI is an Affirmative Action / Equal Employment Opportunity employer.