Medical Only Claim Rep (TX) - Hybrid/Remote at CCMSI in US-TX-Dallas

Job description

• Claim Representative, Medical Only
• Location : Dallas, TX (Hybrid or Remote Opportunity)
• Schedule: Mon - Fri 8:00 am - 4:30 pm (CST)
• Salary Range: $48,000 - $53,000 (Paid hourly)
• 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 claims—we 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.
• 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

Requirements

• Associate Degree or two (2) years of related business experience
• Texas Adjuster's License
• Customer‑service oriented mindset with comfort communicating by phone
• Experience handling claims
• 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
• Knowledge of medical terminology
• Prior experience in claims, insurance, or medical administrative support
• Experience supporting a single client or program environment
• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.

Skills

Preferred

• Knowledge of medical terminology
• Bilingual (Spanish) proficiency

Benefits

• • 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
• 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.
• 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.
• Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations.
• Background checks, if required for the role, are conducted only after a conditional offer and in accordance with applicable fair chance hiring laws.