Hybrid Medical Only Claims Adjuster – Maitland, FL

Job Description

Overview Position Title: Workers' Compensation Claim Adjuster, Medical Only Location: Hybrid - Maitland, FL Hours: Monday - Friday, 8:00 AM to 4:30 PM ET Salary Range: $48,000-$63,500 CCMSI is Hiring! We’re looking for a Workers' Compensation Claim Adjuster, Medical Only to join our team. This role is hybrid, reporting to our Maitland, FL office. At CCMSI, we are employee-owned and committed to providing exceptional service. We offer manageable caseloads, extensive career development, and industry-leading benefits. Why Join CCMSI? Work-Life Balance – Enjoy 4 weeks of PTO in your first year + 10 paid holidays Comprehensive Benefits – Medical, Dental, Vision, 401K, ESOP & moreCareer Growth – Structured training programs with opportunities for advancementSupportive Culture – Work in an environment where your expertise is valued About The Role: The Medical Only Claim Representative will manage designated medical-only claims and provide essential support to the claims staff. This hybrid role is based in our Maitland, FL office, with a schedule of Monday through Friday from 8:00 am to 4:30 pm. The ideal candidate will have basic to intermediate knowledge of medical issues and injuries, with a strong grasp of medical terminology and previous experience handling medical claims being beneficial. Candidates should demonstrate excellent customer service skills, as well as proficiency in presentation and negotiation. Attention to detail and accuracy are crucial, as is the ability to organize effectively and adapt quickly in a fast-paced, ever-changing environment. Problem-solving skills, including the ability to identify, analyze, and resolve issues, are required. Previous experience in a medical office support role is also helpful. This role offers the opportunity to gain experience and may serve as a training ground for potential promotion to an intermediate-level claim position. The Medical Only Claim Representative will be accountable for delivering high-quality claim services in alignment with CCMSI's corporate standards and client expectations. Responsibilities Set up and manage medical files only in accordance with corporate claim standards and law. Establish reserves and/or provide reserve recommendations within established authority levels under direct supervision. Review and approve related medical and miscellaneous invoices on designated claims. Negotiate any disputed bills/invoices for resolution under direct supervision. Request and monitor medical treatment of designated claims in accordance with corporate claim standards. Summarize all correspondence and medical records in claim log notes as well as file same in the appropriate claim. Close claim files when appropriate. Retrieve closed claim files and re-file in storage, as requested. Provide support to claim staff on client service teams. Compliance with Corporate Claim Standards and special client handling instructions as established. Performs other duties as assigned. Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Education and/or Experience Associate Degree or two (2) year's related business experience required.Previous experience in a medical office is helpful.Knowledge of medical terminology preferred. Computer Skills Proficient using Microsoft Office products such as Word, Excel, Outlook. Certificates, Licenses, Registrations FL adjusters license is preferred but not required.The ability to obtain an adjusters license after hire is required. CORE VALUES & PRINCIPLES Responsible for upholding the CCMSI Core Values & Principles which include: performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity; insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better; and leading by example. CCMSI is an Affirmative Action / Equal Employment Opportunity employer offering an excellent benefits package, including Medical, Dental, Vision, Prescription Drug, Life, ESOP, 401K, Flexible Spending, and more. CCMSI conducts background checks in accordance with applicable federal, state, and local laws. Salary Disclaimer: The posted salary range reflects the anticipated base pay for this role. Actual pay will depend on factors such as qualifications, experience, location, and internal equity. Additional compensation may include bonuses, benefits, or other forms of pay. This range complies with state and local transparency laws. Please discuss any questions about compensation or benefits with our hiring team. #J-18808-Ljbffr