Claim Representative, Medical Only (Hybrid)
Company: Ccmsi
Location: Las Vegas
Posted on: May 2, 2024
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Job Description:
Overview:At CCMSI, we look for the best and brightest talent to
join our team of professionals. As a leading Third Party
Administrator in self-insurance services, we are united by a common
purpose of delivering exceptional service to our clients. As an
Employee-Owned Company, we focus on developing our staff through
structured career development programs, rewarding and recognizing
individual and team efforts. Certified as a Great Place To Work,
our employee satisfaction and retention ranks in the 95th
percentile.Reasons you should consider a career with CCMSI:Culture:
Our Core Values are embedded into our culture of how we treat our
employees as a valued partner-with integrity, passion and
enthusiasm.Career development: CCMSI offers robust internships and
internal training programs for advancement within our
organization.Benefits: Not only do our benefits include 4 weeks
paid time off in your first year, plus 10 paid holidays, but they
also include Medical, Dental, Vision, Life Insurance, Critical
Illness, Short and Long Term Disability, 401K, and ESOP.Work
Environment: We believe in providing an environment where employees
enjoy coming to work every day, are provided the resources needed
to perform their job and claims staff are assigned manageable
caseloads.The Medical Only Claim Representative is responsible for
claims handling of designated medical only claims and provide
support to claim staff. This position may be used as a training
position for consideration of promotion to an intermediate level
claim position. Is accountable for the quality of claim services as
perceived by CCMSI clients and within the corporate claim
standards.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.Education and/or
ExperienceAssociate Degree or two (2) year's related business
experience requiredKnowledge of medical terminology
preferred.Computer SkillsProficient using Microsoft Office products
such as Word, Excel, OutlookCertificates, Licenses,
RegistrationsAdjusters license may be required based upon
jurisdiction.Physical DemandsThe physical demands described here
are representative of those that must be met by an employee to
successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with
disabilities to perform the essential functions.Object Handling
CategoriesWork requires the ability to lift/carry objects routinely
as follows:Light Lifting: No lifting of objects weighing more than
15 pounds on a regular basis.Other Physical DemandsWork requires
the ability to stoop, bend, reach and grab with arms and hands,
manual dexterityWork requires the ability to sit or stand up to 7.5
or more hours at a timeWork requires sufficient auditory and visual
acuity to interact with othersCORE VALUES & PRINCIPLESResponsible
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.CCMSI is an Affirmative Action/Equal Employment
Opportunity employer offering an excellent benefit package included
Medical, Dental, Vision, Prescription Drug, Flexible Spending,
Life, ESOP and 401K.by Jobble
Keywords: Ccmsi, Las Vegas , Claim Representative, Medical Only (Hybrid), Healthcare , Las Vegas, Nevada
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