Claim Representative, Medical Only Senior

CCMSI; Phoenix (AZ); Hybrid; USD 50,000 - 65,000; Full time

Benefits offered by this job

4 weeks of paid time off

Comprehensive benefits: Medical, Dental, Vision

Career growth opportunities

Job summary

CCMSI in Phoenix, AZ is seeking a Claim Representative for managing medical-only claims. This role supports the claims staff and adheres to client expectations and corporate standards.

The ideal candidate should have an Arizona Adjuster License and over five years of experience in handling such claims. A hybrid work schedule is available after training.

Qualifications

• Demonstrated flexibility and adaptability in a fast-paced environment.
• High level of discretion with the ability to maintain confidentiality.
• Reliable and consistent attendance within designated client service hours.

Responsibilities

• Manage and administer designated medical-only claims.
• Establish and maintain appropriate reserves.
• Respond promptly to provider and stakeholder inquiries.

Skills

Strong oral and written communication skills

Self-motivated

Excellent organizational skills

Teamwork and collaboration skills

Education

Arizona Adjuster License

ICA Arizona Adjuster Authorization

5 or more years handling medical only claims

Job description

Claim Representative, Medical Only Senior

Location: Phoenix, AZ

Schedule: 8:00am - 4:30pm (MST) Hybrid schedule after initial training period (one day a week in-office)

Salary Range: $50,000 - $65,000 (depending on experience, paid out 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.

Job Summary

Manages designated medical-only claims and provides support to claims staff. Serves as a developmental role with potential advancement to an intermediate claims position. Responsible for delivering high-quality claim service in alignment with CCMSI client expectations and corporate claim standards.

Responsibilities

• Manage and administer designated medical-only claims in compliance with corporate claim standards and applicable laws
• Establish and maintain appropriate reserves within authority limits or provide reserve recommendations
• Review, approve, and negotiate medical and related invoices to ensure accurate and timely payment resolution
• Set up new claim files and ensure all required documentation and system entries are completed accurately
• Maintain claim activity through detailed diary management and timely follow-up
• Coordinate, request, and monitor medical treatment in accordance with established guidelines
• Respond promptly to provider and stakeholder inquiries, including return phone calls
• Document and summarize correspondence, medical records, and claim activity in file notes and maintain organized claim files
• Close claims appropriately and assist with file retrieval and storage as needed
• Deliver high‑quality claim service aligned with client expectations and corporate standards
• Adhere to all corporate claim procedures and specialized client handling instructions
• Support client service teams and contribute to overall client satisfaction
• Provide support and technical guidance to claim staff
• Assist with claim audits and quality reviews for Medical Only I and II adjusters
• Train and mentor newly hired or promoted adjusters
• Partner with team members to develop and implement performance improvement plans as needed
• Handle more complex claims, including national accounts, as assigned
• Manage claims across multiple jurisdictions when required
• Participate in special projects and conduct in-depth research as requested
• Exercise technical oversight of designated claim files
• Work independently with minimal supervision while maintaining high performance standards

Qualifications

Required:

• Strong oral and written communication skills
• Arizona Adjuster License
• ICA Arizona Adjuster Authorization
• 5 or more years handling medical only claims
• Self‑motivated with the ability to work independently and take initiative
• Excellent organizational, coordination, and prioritization skills
• Ability to operate general office equipment and perform clerical tasks
• Demonstrated flexibility and adaptability in a fast‑paced, changing environment
• Ability to work effectively with minimal direct supervision
• High level of discretion with the ability to maintain confidentiality
• Strong teamwork and collaboration skills
• Reliable and consistent attendance within designated client service hours
• Commitment to delivering responsive, high‑quality service to internal and external clients
• Ability to communicate clearly and professionally, both verbally and in writing, with all stakeholders

Nice To Have

• Bilingual (Spanish) proficiency – highly valued for communicating with claimants, employers, or vendors
• Experience supporting municipal accounts is a plus
• Knowledge of medical terminology
• Prior experience in a claims or medical role

Why You’ll Love Working Here

• 4 weeks of paid time off that accrues throughout the year in accordance with company policy plus 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

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.