Claim Representative, Medical Only
CCMSI, Houston, TX, United States
Claim Representative, Medical Only
Location: Houston, Texas
Schedule: 8:00 am - 4:30 pm (CST) – Hybrid after initial training (2 days in‑office per week)
Salary Range: $20-24/hour
Job Summary: Manages designated medical‑only claims and supports claims staff, with opportunity for development and promotion to Medical Only Claim Representative II or Claim Associate I. Accountable for delivering quality claim services that meet corporate standards and client expectations.
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.
Perform other duties as assigned.
Qualifications Required
Associate degree OR two (2) years of related business experience.
Ability to manage medical‑only claims cradle‑to‑grave.
Active Texas Adjuster License.
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. Not required.
Benefits
4 weeks paid time off (accrues throughout the year) + 10 paid holidays in 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: Supportive, team‑based work environment.
Measuring Success
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 every claim represents a real person.
Compensation & Compliance The posted salary reflects a 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 comprehensive benefits and paid time off accruals in accordance with company policy. Retiree plan eligibility is based on plan documents.
CCMSI does not provide visa sponsorship for this position.
ADA accommodations and equal opportunity statements are included in the company's policies and comply with applicable employment laws.
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Job Summary: Manages designated medical‑only claims and supports claims staff, with opportunity for development and promotion to Medical Only Claim Representative II or Claim Associate I. Accountable for delivering quality claim services that meet corporate standards and client expectations.
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.
Perform other duties as assigned.
Qualifications Required
Associate degree OR two (2) years of related business experience.
Ability to manage medical‑only claims cradle‑to‑grave.
Active Texas Adjuster License.
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. Not required.
Benefits
4 weeks paid time off (accrues throughout the year) + 10 paid holidays in 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: Supportive, team‑based work environment.
Measuring Success
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 every claim represents a real person.
Compensation & Compliance The posted salary reflects a 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 comprehensive benefits and paid time off accruals in accordance with company policy. Retiree plan eligibility is based on plan documents.
CCMSI does not provide visa sponsorship for this position.
ADA accommodations and equal opportunity statements are included in the company's policies and comply with applicable employment laws.
#J-18808-Ljbffr