Hybrid Medical Only Claims Adjuster Maitland, FL
About the position
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. The Medical Only Claim Representative will manage designated medical-only claims and provide essential support to the claims staff. This hybrid role is based in our Maitland, FL office, with a schedule of Monday through Friday from 8:00 am to 4:30 pm. The ideal candidate will have basic to intermediate knowledge of medical issues and injuries, with a strong grasp of medical terminology and previous experience handling medical claims being beneficial. Candidates should demonstrate excellent customer service skills, as well as proficiency in presentation and negotiation. Attention to detail and accuracy are crucial, as is the ability to organize effectively and adapt quickly in a fast-paced, ever-changing environment. Problem-solving skills, including the ability to identify, analyze, and resolve issues, are required. Previous experience in a medical office support role is also helpful. This role offers the opportunity to gain experience and may serve as a training ground for potential promotion to an intermediate-level claim position. The Medical Only Claim Representative will be accountable for delivering high-quality claim services in alignment with CCMSI's corporate standards and client expectations.
Responsibilities
Set up and manage medical files only in accordance with corporate claim standards and law.
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Establish reserves and/or provide reserve recommendations within established authority levels under direct supervision.
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Review and approve related medical and miscellaneous invoices on designated claims. Negotiate any disputed bills/invoices for resolution under direct supervision.
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Request and monitor medical treatment of designated claims in accordance with corporate claim standards.
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Summarize all correspondence and medical records in claim log notes as well as file same in the appropriate claim.
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Close claim files when appropriate.
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Retrieve closed claim files and re-file in storage, as requested.
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Provide support to claim staff on client service teams.
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Compliance with Corporate Claim Standards and special client handling instructions as established.
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Performs other duties as assigned.
Requirements
Associate Degree or two (2) year's related business experience required
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Previous experience in a medical office is helpful.
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Knowledge of medical terminology preferred.
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Proficient using Microsoft Office products such as Word, Excel, Outlook.
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FL adjusters license is preferred but not required. The ability to obtain an adjusters license after hire is required.
Nice-to-haves
Basic to intermediate knowledge of medical issues and injuries.
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Strong grasp of medical terminology.
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Excellent customer service skills.
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Proficiency in presentation and negotiation.
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Attention to detail and accuracy.
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Ability to organize effectively and adapt quickly in a fast-paced environment.
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Problem-solving skills, including the ability to identify, analyze, and resolve issues.
Benefits
4 weeks paid time off in your first year
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10 paid holidays
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Medical, Dental, Vision, Life Insurance
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Critical Illness, Short and Long Term Disability
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401K
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Employee Stock Ownership Plan (ESOP)
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