Claim Assistant [United States]

 

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:

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  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 Claim Assistant will investigate and evaluate contested medical-only claims and handle indemnity cases under close supervision. 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 service as perceived by CCMSI clients and within Corporate Claim Standards.

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.
• 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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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  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.

Education and/or Experience

Associate’s degree or two year’s related business experience.

Knowledge of medical terminology preferred.

Computer Skills

Proficient with Microsoft Office programs.

CORE VALUES & PRINCIPLES

Responsible 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 including Medical, Dental, Prescription Drug, Vision, Flexible Spending, Life, ESOP and 401K.

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