Claim Representative, Medical Only
US-NM-Albuquerque
CCMSI
Req #: 6089
Type: Regular Full-Time
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Overview: Medical Only Claim Representative Location: Albuquerque, NM - In-OfficeSchedule: Monday-Friday, 8:00 AM-4:30 PM MT (37.5 hours/week)Hourly Rate: $19.00-$21.00 per hour Build Your Career With Purpose at CCMSI At CCMSI, we don't just process claims-we support people. As a leading Third Party Administrator and a certified Great Place to Work(r), we offer manageable caseloads, employee ownership, and a collaborative culture. Our employee-owners are empowered to grow, contribute, and make a meaningful impact. Job Summary As a Medical Only Claim Representative, you'll be responsible for managing medical-only workers' compensation claims and providing support to the broader claim team. This role may serve as a training opportunity for advancement into an intermediate-level claim role. You'll work in a fast-paced environment where attention to detail, file quality, and customer service matter every day. Responsibilities: What You'll Do * Set up and manage medical-only claims in accordance with CCMSI standards and applicable laws * Establish and recommend reserves under direct supervision * Review, approve, and negotiate medical and miscellaneous bills as needed * Coordinate medical treatment and follow-up for designated claims * Document file activity thoroughly and accurately in claim systems * Close claim files as appropriate and refile closed files as requested * Provide clerical and administrative support to claim staff * Maintain compliance with client handling instructions and corporate claim procedures Qualifications: What You'll Bring Required: * Associate degree or 2+ years of relevant business or administrative experience * Strong organizational and communication skills * Ability to use Microsoft Office products, including Word, Excel, and Outlook * Ability to pass a background check required for NM adjuster licensing Nice to Have: * Prior workers' compensation or insurance claims experience * Knowledge of medical terminology * NM Adjuster License (preferred, or willingness to obtain after hire) How We Measure Success * Accuracy and timeliness of claim handling * File quality and audit results * Responsiveness to internal team and client needs * Efficient management of queues and documentation What We Offer * 4 weeks of PTO + 10 paid holidays in your first year * Medical, Dental, Vision, Life, and Disability Insurance * 401(k) and Employee Stock Ownership Plan (ESOP) * Internal training and career advancement opportunities * A supportive and team-focused work environment Compensation & Compliance The posted wage reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual pay will be based on experience, qualifications, and internal equity. This role may also be eligible for additional compensation or bonuses. Visa Sponsorship: CCMSI does not provide visa sponsorship for this position.ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. If you need assistance or accommodation, please contact our team. Equal Opportunity Employer: CCMSI is an Affirmative Action / Equal Employment Opportunity employer. We comply with all applicable employment laws, including pay transparency and fair chance hiring regulations. Background checks are conducted only after a conditional offer of employment. Our Core Values At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who: * Act with integrity * Deliver service with passion and accountability * Embrace collaboration and change * Seek better ways to serve * Build up others through respect, trust, and communication * Lead by example-no matter their title We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you. #NowHiring #JoinOurTeam #EmployeeOwned #CCMSI #CareerWithPurpose #ClaimsCareers #TPAcareers #MedicalOnlyClaims #WorkersComp #AlbuquerqueJobs #InsuranceJobsNM #StartYourCareer #GreatPlaceToWork #GrowWithUs #IND456 #LI-InOffice
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