Claim Representative, Medical Only Senior

Overview

Claim Representative, Medical Only Senior

Location: Phoenix, AZ 

Schedule: 8:00am - 4:30pm (MST) Hybrid schedule after initial training period (one day a week in-office)

Salary Range: $50,000 - $65,000 (depending on experience, paid out hourly) 

Responsibilities

When we hire claim reps at CCMSI, we look for detail oriented professionals who understand that every task supports a real person’s claim experience, value accuracy and responsiveness, and contribute to the team’s success through organization, collaboration, and a strong commitment to service.

• Manage and administer designated medical-only claims in compliance with corporate claim standards and applicable laws
• Establish and maintain appropriate reserves within authority limits or provide reserve recommendations
• Review, approve, and negotiate medical and related invoices to ensure accurate and timely payment resolution
• Set up new claim files and ensure all required documentation and system entries are completed accurately
• Maintain claim activity through detailed diary management and timely follow-up
• Coordinate, request, and monitor medical treatment in accordance with established guidelines
• Respond promptly to provider and stakeholder inquiries, including return phone calls
• Document and summarize correspondence, medical records, and claim activity in file notes and maintain organized claim files
• Close claims appropriately and assist with file retrieval and storage as needed
• Deliver high-quality claim service aligned with client expectations and corporate standards
• Adhere to all corporate claim procedures and specialized client handling instructions
• Support client service teams and contribute to overall client satisfaction
• Provide support and technical guidance to claim staff
• Assist with claim audits and quality reviews for Medical Only I and II adjusters
• Train and mentor newly hired or promoted adjusters
• Partner with team members to develop and implement performance improvement plans as needed
• Handle more complex claims, including national accounts, as assigned
• Manage claims across multiple jurisdictions when required
• Participate in special projects and conduct in-depth research as requested
• Exercise technical oversight of designated claim files
• Work independently with minimal supervision while maintaining high performance standards

Qualifications

Required:

• Strong oral and written communication skills
• Arizona Adjuster License

• ICA Arizona Adjuster Authorization

• 5 or more years handling medical only claims
• Self-motivated with the ability to work independently and take initiative
• Excellent organizational, coordination, and prioritization skills
• Ability to operate general office equipment and perform clerical tasks
• Demonstrated flexibility and adaptability in a fast-paced, changing environment
• Ability to work effectively with minimal direct supervision
• High level of discretion with the ability to maintain confidentiality
• Strong teamwork and collaboration skills
• Reliable and consistent attendance within designated client service hours
• Commitment to delivering responsive, high-quality service to internal and external clients
• Ability to communicate clearly and professionally, both verbally and in writing, with all stakeholders

Nice to Have:

• Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, or vendors.
• Experience supporting municipal accounts is a plus
• Knowledge of medical terminology 
• Prior experience in a claims or medical 

 At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by: 

• Lead with transparency We build trust by being open and listening intently in every interaction. 
• Perform with integrity We choose the right path, even when it is hard. 
• Chase excellence We set the bar high and measure our success. What gets measured gets done. 
• Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own. 
• Win together Our greatest victories come when our clients succeed.