Claim Representative, Medical Only (In?Office Albuquerque, NM)
CCMSI, Albuquerque, NM, United States
Medical Only Claim Representative
The Medical Only Claim Representative is responsible for managing medical-only workers' compensation claims from start to finish for a multiple-client desk spanning various industries within the New Mexico jurisdiction. This role focuses on quality medical management, accurate documentation, and compliance with CCMSI standards and client handling instructions. This is an in-office position in Albuquerque, NM, with a potential opportunity for a hybrid schedule in the future based on performance and business needs. This role may also serve as a training and development position for advancement into higher-level claim roles. Responsibilities
Set up and manage medical-only workers' compensation claim files in accordance with corporate standards and New Mexico regulations Review incoming medical documentation and summarize correspondence and records in claim notes Establish initial reserves and provide reserve recommendations under direct supervision Review, approve, and process medical and miscellaneous invoices related to designated claims Assist with bill negotiations or dispute resolution under guidance Coordinate and monitor medical treatment to ensure timely and appropriate care Maintain accurate, timely, and well-documented electronic claim files Close claim files when appropriate and retrieve closed files as needed Support claim staff and client service teams with medical-only claim activity Maintain compliance with corporate claim handling standards and client-specific instructions Qualifications
Required:
Associate degree OR two (2) years of related business experience Ability to manage medical-only claims cradle-to-grave Active New Mexico Adjuster License OR ability to obtain within 60 days of hire Strong attention to detail and organization skills Ability to follow established procedures and meet deadlines Proficiency with Microsoft Office (Word, Excel, Outlook) Strong written and verbal communication skills Reliable, predictable attendance during scheduled hours Ability to work in a fast-paced, in-office environment Nice to Have:
Prior medical-only or workers' compensation claims experience Knowledge of medical terminology Experience working with multiple clients or industries Prior experience in a TPA environment Bilingual (Spanish) proficiency highly valued for communicating with claimants, employers, or vendors, but not required. Why You'll Love Working Here
4 weeks (Paid time off that accrues throughout the year in accordance with company policy) + 10 paid holidays in your first year Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP) Career growth: Internal training and advancement opportunities Culture: A supportive, team-based work environment How We Measure Success
At CCMSI, medical-only claim professionals succeed through accuracy and consistency. Success in this role is measured by: Queue management timely handling of assigned medical-only claims Audit performance compliance with corporate standards and NM regulations Accuracy & documentation clear, complete, and timely claim notes File progression appropriate reserve activity and timely claim closure Team support & reliability responsiveness and dependable in-office attendance Cultural alignment recognizing that every claim represents a real person This is where we shine, and we hire claim professionals who want to shine with us. 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. CCMSI offers comprehensive benefits including medical, dental, vision, life, and disability insurance. Paid time off accrues throughout the year in accordance with company policy, with paid holidays and eligibility for retirement programs in accordance with plan documents. Visa Sponsorship: CCMSI does not provide visa sponsorship for this position. ADA Accommodations : CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations. Background checks, if required for the role, are conducted only after a conditional offer and in accordance with applicable fair chance hiring laws. Our Core Values
At CCMSI, we believe in doing what's rightfor our clients, our coworkers, and ourselves. We look for team members who: Lead with transparency We build trust by being open and listening intently in every interaction. Perform with integrity We choose the right path, even when it is hard. Chase excellence We set the bar high and measure our success. What gets measured gets done. Own the outcome Every employee is an owner, treating every claim and decision as our own. Win together Our greatest victories come when our clients succeed. We don't just work togetherwe grow together. If that sounds like your kind of workplace, we'd love to meet you.
The Medical Only Claim Representative is responsible for managing medical-only workers' compensation claims from start to finish for a multiple-client desk spanning various industries within the New Mexico jurisdiction. This role focuses on quality medical management, accurate documentation, and compliance with CCMSI standards and client handling instructions. This is an in-office position in Albuquerque, NM, with a potential opportunity for a hybrid schedule in the future based on performance and business needs. This role may also serve as a training and development position for advancement into higher-level claim roles. Responsibilities
Set up and manage medical-only workers' compensation claim files in accordance with corporate standards and New Mexico regulations Review incoming medical documentation and summarize correspondence and records in claim notes Establish initial reserves and provide reserve recommendations under direct supervision Review, approve, and process medical and miscellaneous invoices related to designated claims Assist with bill negotiations or dispute resolution under guidance Coordinate and monitor medical treatment to ensure timely and appropriate care Maintain accurate, timely, and well-documented electronic claim files Close claim files when appropriate and retrieve closed files as needed Support claim staff and client service teams with medical-only claim activity Maintain compliance with corporate claim handling standards and client-specific instructions Qualifications
Required:
Associate degree OR two (2) years of related business experience Ability to manage medical-only claims cradle-to-grave Active New Mexico Adjuster License OR ability to obtain within 60 days of hire Strong attention to detail and organization skills Ability to follow established procedures and meet deadlines Proficiency with Microsoft Office (Word, Excel, Outlook) Strong written and verbal communication skills Reliable, predictable attendance during scheduled hours Ability to work in a fast-paced, in-office environment Nice to Have:
Prior medical-only or workers' compensation claims experience Knowledge of medical terminology Experience working with multiple clients or industries Prior experience in a TPA environment Bilingual (Spanish) proficiency highly valued for communicating with claimants, employers, or vendors, but not required. Why You'll Love Working Here
4 weeks (Paid time off that accrues throughout the year in accordance with company policy) + 10 paid holidays in your first year Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP) Career growth: Internal training and advancement opportunities Culture: A supportive, team-based work environment How We Measure Success
At CCMSI, medical-only claim professionals succeed through accuracy and consistency. Success in this role is measured by: Queue management timely handling of assigned medical-only claims Audit performance compliance with corporate standards and NM regulations Accuracy & documentation clear, complete, and timely claim notes File progression appropriate reserve activity and timely claim closure Team support & reliability responsiveness and dependable in-office attendance Cultural alignment recognizing that every claim represents a real person This is where we shine, and we hire claim professionals who want to shine with us. 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. CCMSI offers comprehensive benefits including medical, dental, vision, life, and disability insurance. Paid time off accrues throughout the year in accordance with company policy, with paid holidays and eligibility for retirement programs in accordance with plan documents. Visa Sponsorship: CCMSI does not provide visa sponsorship for this position. ADA Accommodations : CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations. Background checks, if required for the role, are conducted only after a conditional offer and in accordance with applicable fair chance hiring laws. Our Core Values
At CCMSI, we believe in doing what's rightfor our clients, our coworkers, and ourselves. We look for team members who: Lead with transparency We build trust by being open and listening intently in every interaction. Perform with integrity We choose the right path, even when it is hard. Chase excellence We set the bar high and measure our success. What gets measured gets done. Own the outcome Every employee is an owner, treating every claim and decision as our own. Win together Our greatest victories come when our clients succeed. We don't just work togetherwe grow together. If that sounds like your kind of workplace, we'd love to meet you.