Claim Representative, Medical Only

Workers' Compensation Claim Adjuster, Medical Only (NY, FL)

Position Title: Workers' Compensation Claim Adjuster, Medical Only (NY, FL)

Location: Branch located in Maitland, FL (Greater Orlando Area): remote reporting eligible

Hours: Monday - Friday, 8:00 AM to 4:30 PM ET

Salary Range: $23/hr - $25/hr

Build Your Career With Purpose at CCMSI

At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success. We don't just process claimswe support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work, and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day.

Job Summary

The Medical Only Claim Representative is responsible for claims handling of designated medical only claims and provide support to claim staff. 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 services as perceived by CCMSI clients and within the corporate claim standards.

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.

• Set up and manage medical-only claim files in accordance with corporate claim standards and applicable laws
• Establish reserves and provide reserve recommendations within authorized levels under direct supervision
• Review and approve medical and miscellaneous invoices on designated claims; negotiate disputed bills or invoices under supervision
• Request and monitor medical treatment in accordance with corporate claim handling standards
• Summarize correspondence and medical records in claim system notes and file documentation appropriately
• Close claim files when appropriate and retrieve closed files for re-filing as requested
• Provide ongoing support to claim staff on client service teams
• Communicate with medical providers, injured workers, and internal partners; frequent phone work is required
• Ensure compliance with corporate claim handling standards and special client handling instructions

Qualifications

Required:

• Associate Degree or two (2) years of related business experience
• Customer-service oriented mindset with comfort communicating by phone
• Strong organizational skills and ability to multitask effectively
• Ability to work efficiently on a computer and manage detailed documentation
• Proficiency with Microsoft Office applications including Word, Excel, and Outlook
• Reliable, predictable attendance during assigned business hours.
• Experience adjusting NY and FL medical only claims, other possible jurisdictions: PA, NJ, DE

Nice to Have:

• Knowledge of medical terminology
• Prior experience in claims, insurance, or medical administrative support
• Experience supporting a single client or program environment
• Bilingual (Spanish) proficiencyhighly 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

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.