Claim Representative, Medical Only

CCMSI; Reno (NV); On-site; USD 45,000 - 55,000; Full time

Benefits offered by this job

4 weeks PTO

Comprehensive benefits

401(k) and ESOP

Career growth opportunities

Team environment

Job summary

CCMSI in Reno, NV is seeking a Medical Only Claim Representative to handle designated medical-only claims and support the claims team. The role emphasizes accurate file setup, reserving within approved limits, and timely documentation in the claim system.

As a potential training position, this role offers growth toward an intermediate claims position, with a focus on client service, compliance with corporate standards, and collaboration with medical providers and internal partners.

Qualifications

• Associate degree or two years of related business experience.
• Customer-service oriented with comfort communicating by phone.
• Strong organizational and multitasking abilities.
• Proficient with Microsoft Office (Word, Excel, Outlook).
• Reliable, predictable attendance during assigned business hours.

Responsibilities

• Set up and manage medical‑only claim files per standards.
• Establish reserves and provide reserve recommendations.
• Review invoices and negotiate bills under supervision.
• Monitor medical treatment per standards.
• Summarize medical records and correspondence in the system.
• Close and retrieve claim files as requested.
• Provide ongoing support to claim staff on client teams.
• Communicate with medical providers, injured workers, and internal partners.
• Ensure compliance with handling standards and client instructions.

Skills

Customer service

Phone communication

Organization

Computer skills

Attendance reliability

Education

Associate Degree or 2 years related business experience

Tools

Microsoft Office

Job description

Overview

Claim Representative, Medical Only

Location: Reno, NV

Schedule: Mon - Fri 7:30 am - 4pm (PST)

Salary Range: $45,000 - $55,000 (paid hourly depending on experience)

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.

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

• 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

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) 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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