Claim Assistant
Company: CCMSI
Location: Scottsdale
Posted on: May 15, 2022
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 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.
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 ExperienceAssociate's
degree or two year's related business experience.Knowledge of
medical terminology preferred.
Computer SkillsProficient with Microsoft Office programs.
Certificates, 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 sit or stand up
to 7.5 or more hours at a time.Work requires sufficient auditory
and visual acuity to interact with others.
CORE 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 including Medical,
Dental, Prescription Drug, Vision, Flexible Spending, Life, ESOP
and 401K.
Keywords: CCMSI, Scottsdale , Claim Assistant, Other , Scottsdale, Arizona
Didn't find what you're looking for? Search again!
Loading more jobs...