Claim Representative, Medical Only

CCMSI; Carson City (NV); Hybrid; USD 32,000 - 34,000; Full time

Benefits offered by this job

Paid time off

Holidays

Medical, dental, vision

Job summary

CCMSI is seeking a Medical Only Claim Representative in a hybrid role based in Carson City or Reno, NV. The position handles Nevada medical-only workers' compensation claims with an emphasis on accurate documentation, timely progress, and regulatory compliance.

Schedule is Monday–Friday, 8:00 AM–4:30 PM, 37.5 hours/week, with a pay range of $22–$25 per hour. The role supports career development toward intermediate adjusting and focuses on claims handling, client collaboration, and file

Qualifications

• NV Adjuster License or ability to obtain within 90 days of hire.
• Associate Degree or two years of related business experience.
• Strong organizational skills and 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.

Responsibilities

• 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.

Skills

Organizational skills

Microsoft Office

Written and verbal communication

Accurate documentation

Education

Associate degree or 2 years related experience

Tools

Microsoft Office (Word, Excel, Outlook)

Job description

Medical Only Claim Representative

Overview

Location: Hybrid - Carson City, NV or Reno, NV

Schedule: Monday-Friday, 8:00 AM-4:30 PM (37.5 hours/week)

Salary Range: $22 to $25/hr (hourly position)

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.

Job Summary

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 claims - not an HR or consulting role.

Responsibilities

• 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.

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

• 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.

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.

Our Core Values

• 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 together - we grow together. If that sounds like your kind of workplace, we'd love to meet you.

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