CCMSI · 1 week ago
Claim Assistant
US-FL-Maitland
Full-time
Onsite
Entry Level
$18/hr - $19/hr
2+ years expCCMSI is a leading Third Party Administrator focused on providing customized claim solutions to clients. The Claim Assistant will investigate and evaluate contested medical-only claims and handle indemnity cases under close supervision, ensuring quality service and compliance with corporate standards.
Financial ServicesInsuranceRetail
No H1B
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 set up 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 within Corporate Claim Standards, client specific handling instructions and state laws under direct supervision, when appropriate
As appropriate, make referrals to outside vendors on designated cases under direct supervision. (i.e. legal, surveillance, case management, etc.)
Effective and timely coordination of 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
Compliance with corporate claim standards and special client handling instructions as established
Qualification
Required
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
Associate's degree or two year's related business experience
Proficient with Microsoft Office programs
Adjusters license may be required based upon jurisdiction
Preferred
Knowledge of medical terminology
Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required
Benefits
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
Company
CCMSI
CCMSI is a third-party administrator for workers' compensation and property/casualty self-insurance programs.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
G
G. Bryan G. Bryan Thomas
President/CEO
Company data provided by crunchbase