Claim Representative, Medical Only

Medical Only Claim Representative

The Medical Only Claim Representative manages a designated caseload of Nevada workers' compensation medical-only claims for a multi-account desk. This role focuses on accurate, timely, and compliant claim handling, ensuring strong documentation, customer service, and file progression. This position may support career development toward an intermediate-level adjusting role. This is a true workers' compensation adjuster position responsible for managing claimsnot an HR or consulting role.

Responsibilities

We hire adjusters who take ownership, communicate with purpose, and move files with integrity and accuracy.

• Set up and manage Nevada medical-only workers' compensation claims in accordance with corporate claim standards and statutory requirements.
• Establish reserves and/or provide reserve recommendations within assigned authority levels under supervision.
• Review, approve, and negotiate medical and miscellaneous invoices related to assigned claims.
• Request, track, and monitor medical treatment to ensure timely and appropriate care.
• Maintain accurate and timely claim documentation, including detailed log notes and diary management.
• Summarize medical records and correspondence and ensure documentation is properly filed.
• Participate in claim reviews and collaborate with client service teams.
• Close claim files when appropriate and retrieve/return closed files to storage as needed.
• Maintain compliance with Nevada regulations, corporate Best Practices, and client-specific handling instructions.

Qualifications

What You'll Bring...

Required

• NV Adjuster License (or the ability to obtain within 90 days of hire)
• Associate Degree or two (2) years of related business experience
• Strong organizational skills and the ability to manage multiple tasks and deadlines
• Proficiency in Microsoft Office (Word, Excel, Outlook)
• Effective written and verbal communication skills
• Ability to maintain accurate, timely documentation and purposeful file movement

Nice to Have

• Knowledge of medical terminology
• Prior experience in workers' compensation or claims administration
• Industry certifications or CEU credits supporting licensure
• Experience supporting multi-account claims desks
• Strong detail orientation and time-management skills
• Bilingual (Spanish) proficiency highly valued for communicating with claimants, employers, or vendors, but not required.

Why You'll Love Working Here

• 4 weeks (Paid time off that accrues throughout the year in accordance with company policy) + 10 paid holidays in your first year
• Comprehensive benefits : Medical, Dental, Vision, Life, and Disability Insurance
• Retirement plans : 401(k) and Employee Stock Ownership Plan (ESOP)
• Career growth : Internal training and advancement opportunities
• Culture : A supportive, team-based work environment

How We Measure Success

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

• Quality claim handling thorough investigations, strong documentation, well-supported decisions
• Compliance & audit performance adherence to jurisdictional and client standards
• Timeliness & accuracy purposeful file movement and dependable execution
• Client partnership proactive communication and strong follow-through
• Professional judgment owning outcomes and solving problems with integrity
• Cultural alignment believing every claim represents a real person and acting accordingly

This is where we shine, and we hire adjusters who want to shine with us.

Compensation & Compliance

The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.

CCMSI offers comprehensive benefits including medical, dental, vision, life, and disability insurance. Paid time off accrues throughout the year in accordance with company policy, with paid holidays and eligibility for retirement programs in accordance with plan documents.

Our Core Values

At CCMSI, we believe in doing what's rightfor our clients, our coworkers, and ourselves. We look for team members who:

• 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.

We don't just work togetherwe grow together. If that sounds like your kind of workplace, we'd love to meet you.

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