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claim representative, medical only Jobs in Houston

claim representative, medical only

claim specialist - correctional medicine Jobs in Houston

claim specialist - correctional medicine

claim specialist - healthcare professional liability Jobs in Houston

claim specialist correctional medicine

Gallagher

<div><b>Introduction</b><br>
<div>
At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it&rsquo;s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people&rsquo;s lives. It takes empathy, precision, and a strong sense of partnership&mdash;and that&rsquo;s exactly what you&rsquo;ll find here. We&rsquo;re a team of fast-paced fixers, empathetic experts, and outcomes drivers &mdash; people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you&rsquo;ll play a vital role in helping businesses and individuals move forward with confidence. Here, you&rsquo;ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you&rsquo;re here, you&rsquo;re part of something bigger. You&rsquo;re part of a team that shows up, stands together, and leads with purpose.
</div><br>
<b>Overview</b><div><b><br>
Salary: </b>Salary for this position could go up to $119,000 per year, dependent upon experience.</div><div><div><b>
Jurisdictions:</b> Open to any</div><div><b>
Licenses:</b> Must be willing to obtain all licenses as required by the manager within a specified timeframe</div><div><b>
Location:</b> This role is eligible for fully remote work</div><div></div><div><br>
The Claims Specialist within GB Specialty is responsible for managing moderately complex <b>Healthcare Professional Liability</b> claims, with a primary focus on <b>Correctional Medicine</b>. This role manages the full claim life cycle, including coverage analysis, investigation, evaluation, and resolution, while ensuring claims are handled in accordance with client expectations, policy obligations, and regulatory requirements.</div></div>
<br>
<b>How you'll make an impact</b><br>
<ul><li>
Analyzes coverage and settles moderately complex claims in Correctional Medicine Professional Liability.</li><li>
Generally, incumbent does not work on workers&rsquo; compensation claims.</li><li>
Able to manage the full-life cycle of all assigned claims files.</li><li>
Analyzes coverage and determines defense obligations.</li><li>
Under minimal supervision, conducts thorough analysis and investigations necessary to determine claims exposure and recommend appropriate settlement strategies and action plans.</li><li>
Creates reservation of rights and coverage denial letters.</li><li>
Negotiates settlements with clients, client attorneys, and Public Adjusters.</li><li>
Interacts extensively with various parties involved in the claims process, and may recommend retaining the advice of outside experts as necessary.</li><li>
Prepares reserve and settlement authority requests for client and carrier approval.</li><li>
May act as a client advocate with carriers to ensure proper claims handling, including any necessary scoping, estimating, and addressing of coverage.</li><li>
Has a solid understanding of claims processing and the insurance brokerage business.</li><li>
Has a basic understanding of the terminology and case law associated with correctional medicine professional liability claims.</li><li>
Handles claims consistent with clients&rsquo; and corporate policies, procedures and best practices and in accordance with statutory, regulatory, and ethical requirements.</li><li>
Incumbents at this level should be able to work at full caseload capacity.</li></ul>
<br>
<b>About You</b><div><b><br>
Required:</b></div><ul><li><div>
Bachelor&rsquo;s degree required</div></li><li><div>
Minimum 2+ years of experience in handling professional liability claims</div></li><li><div>
Strong insurance fundamentals and understanding of claims processes.</div></li><li><div>
Ability to analyze documentation, summarize facts, and support coverage and liability determinations.</div></li><li><div>
Computer proficiency with claims systems and standard business software.</div></li><li><div>
Must be able to obtain required adjuster licenses within designated timeframes.</div></li></ul><div><b>
Preferred:
</b></div><ul><li>Prior experience within healthcare, medical malpractice, or correctional medicine claims a plus.</li><li>
Strong insurance background (carrier, TPA, brokerage, or claims support experience).</li><li>
JD preferred but not required</li></ul><div><b>
Behaviors:</b></div><div><ul><li>
Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, and communicate effectively in writing and verbally.</li><li>
Strong analytical skills to support claims decisions and issue resolution.</li><li>
Ability to interpret policies, records, and related documentation.</li></ul><div>
#LI-TJ1</div><div>
#GBSpecialtyCareers</div></div></div>

Claim Specialist - Correctional Medicine

<div><b>Introduction</b><br>
<div>
At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it&rsquo;s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people&rsquo;s lives. It takes empathy, precision, and a strong sense of partnership&mdash;and that&rsquo;s exactly what you&rsquo;ll find here. We&rsquo;re a team of fast-paced fixers, empathetic experts, and outcomes drivers &mdash; people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you&rsquo;ll play a vital role in helping businesses and individuals move forward with confidence. Here, you&rsquo;ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you&rsquo;re here, you&rsquo;re part of something bigger. You&rsquo;re part of a team that shows up, stands together, and leads with purpose.
</div><br>
<b>Overview</b><br>
<div><b>
Salary:</b> Salary can be up to $120,000 per year, dependent upon experience</div><div><b>
Claims Background:</b> Professional Liability Claims, Paralegal experience, or related insurance support role<br>
<b>Jurisdictional Experience:</b> Open to any<br>
<b>Active Adjuster Licenses:</b> Must be willing to obtain all licenses as required by the manager within a specified timeframe</div><div>
</div><div>
The Claims Specialist within GB Specialty is responsible for managing moderately complex <b>Healthcare Professional Liability</b> claims. This role manages the full claim life cycle, including coverage analysis, investigation, evaluation, and resolution, while ensuring claims are handled in accordance with client expectations, policy obligations, and regulatory requirements.</div>
<br>
<b>How you'll make an impact</b><br>
<ul><li>
Analyzes coverage and settles moderately complex claims in Healthcare Professional Liability.</li><li>
Generally, incumbent does not work on workers&rsquo; compensation claims.</li><li>
Able to manage the full-life cycle of all assigned claims files.</li><li>
Analyzes coverage and determines defense obligations.</li><li>
Under minimal supervision, conducts thorough analysis and investigations necessary to determine claims exposure and recommend appropriate settlement strategies and action plans.</li><li>
Creates reservation of rights and coverage denial letters.</li><li>
Negotiates settlements with clients, client attorneys, and Public Adjusters.</li><li>
Interacts extensively with various parties involved in the claims process, and may recommend retaining the advice of outside experts as necessary.</li><li>
Prepares reserve and settlement authority requests for client and carrier approval.</li><li>
May act as a client advocate with carriers to ensure proper claims handling, including any necessary scoping, estimating, and addressing of coverage.</li><li>
Has a solid understanding of claims processing and the insurance brokerage business.</li><li>
Has a basic understanding of the terminology and case law associated with correctional medicine professional liability claims.</li><li>
Handles claims consistent with clients&rsquo; and corporate policies, procedures and best practices and in accordance with statutory, regulatory, and ethical requirements.</li><li>
Incumbents at this level should be able to work at full caseload capacity.</li></ul>
<br>
<b>About You</b><br>
<div><b>
Claims Background:</b> Paralegal experience, junior professional liability claims experience, or insurance claims support background, preferably within healthcare or medical professional liability</div><div><b>
Jurisdictional Experience:</b> Open to any<br>
<b>Active Adjusters&rsquo; Licenses:</b> Not required initially; must be willing to obtain licenses as directed</div><div></div><div><b><br>
Required:</b></div><br>
<div></div><ul><li>
Bachelor's Degree Required</li><li>
Minimum 2 years of experience in claims, insurance, paralegal, legal support, or a related environment.</li><li>
Strong insurance fundamentals and understanding of claims processes.</li><li>
Ability to analyze documentation, summarize facts, and support coverage and liability determinations.</li><li>
Computer proficiency with claims systems and standard business software.</li><li>
Must be able to obtain required adjuster licenses within designated timeframes.</li></ul><div><b><br>
Preferred:</b></div><ul><li>
Prior experience within healthcare (medical malpractice) claims is a plus</li></ul><div><b>
Behaviors:</b><ul><li>
Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, and communicate effectively in writing and verbally.</li><li>
Strong analytical skills to support claims decisions and issue resolution.</li><li>
Ability to interpret policies, records, and related documentation.</li></ul><div>
#LI-TJ1</div><div>
#GBSpecialtyCareers</div></div></div><div></div>

Claim Specialist - Healthcare Professional Liability

Baylor College of Medicine

<div><div><div><div><h2 class="jobSectionHeader"><b>Summary</b></h2></div><div><p>
Patient Business Services is seeking a Coordinator, Patient Accounts Receivable to expedite and maximize payment of insurance medical claims by contacting insurance payers and patients by telephone or website.</p></div></div><div><div><h2 class="jobSectionHeader"><b>
Job Duties</b></h2></div><div><ul><li>
Expedites and maximizes payment of insurance medical claims by contacting insurance payers and patients by telephone or website.</li><li>
Works on complex and/or specialized cases.</li><li>
Provides assistance with inquiries from outside parties regarding account status and possible resolutions.</li><li>
Utilizes specialized knowledge of regulatory or contractual billing guidelines to determine an account&rsquo;s ability to pay after initial rejection from payer.</li><li>
Resolves all denials, and requests for information, including appeals.</li><li>
Identifies trends in payer non-compliance and informs management accordingly.</li><li>
Follows up on outstanding accounts and makes proper notations in EPIC system and logs.</li><li>
May provide guidance and technical work direction to less experienced staff.</li><li>
Performs other job-related duties as assigned.</li></ul></div></div><div><div><h2 class="jobSectionHeader"><b>
Minimum Qualifications</b></h2></div><div><ul><li>
High School Diploma or GED.</li><li>
Minimum of two years of experience working in a medical setting, to include medical insurance and/or accounts receivable follow-up.</li></ul></div></div><div><div><h2 class="jobSectionHeader"><b>
Preferred Qualifications</b></h2></div><div><ul><li>
A/R follow up experience.</li><li>
Experience speaking with insurance company reps for claim status.</li><li>
Experience accessing payer websites for claim information.</li><li>
Experience submitting appeals for reimbursement.</li></ul></div></div></div><p></p><p><b><br>
Work Authorization Requirement:</b></p><p><b>
This position is not eligible for visa sponsorship.</b> Candidates must be legally authorized to work in the United States at the time of application and throughout the duration of employment.</p><p></p><p><br>
Baylor College of Medicine is an Equal Opportunity/Affirmative Action/Equal Access Employer.</p></div>

Coordinator, Patient Accounts Receivable - Appeals/Denials

Allied Universal Compliance and Investigations

<div><p>SIU Investigator</p><h2 class="jobSectionHeader"><b>
Overview</b></h2><p>
Company Overview:
</p><p>Advance Your Career in Insurance Claims with Allied Universal&reg; Compliance and Investigation Services. Allied Universal&reg; Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you're ready to grow with the best, explore a career with us and make a difference.</p><h2 class="jobSectionHeader"><b>
Job Description</b></h2><p>
Allied Universal&reg; is hiring a Special Investigations Unit (SIU) Investigator. Special Investigations Unit (SIU) Specialists investigate claims with red flags that suggest fraudulent behavior In relation to an Insurance claim. The SIU Specialist must use their extensive knowledge of Insurance policies and the components of fraud to determine If claims warrant reporting to the appropriate state agency for prosecution.</p><p><br>
</p><ul><li><b>Join a well-established company with a strong reputation in the industry!</b></li><li><b>
Auto Allowance and Company Credit Card for fuel and travel!</b></li><li><b>
Must possess a valid driver's license with at least one year of driving experience</b></li></ul><br>
<p></p>
<p><b>RESPONSIBILITIES:</b>
</p><ul><li>Independently investigate suspected fraudulent insurance claims for a variety of coverage to include workers' compensation, general liability, property and casualty and disability</li>
<li>Acquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance</li>
<li>Create and maintain detailed documentation for investigations, file reviews, audits, training tasks, consulting projects, and other assignments as directed</li>
<li>Produce professional and expert reports, memos, and letters that are clear, concise, and grammatically correct</li>
<li>Run appropriate database indices if necessary and verify the accuracy of results found</li>
<li>Independently develop a strategic plan to achieve assignment objectives, ensuring thorough documentation and effective communication with clients and their Special Investigation Unit Supervisor</li></ul><p><b>
QUALIFICATIONS (MUST HAVE):</b>
</p><ul><li>Must possess one or more of the following:</li><li><ul><li>
Bachelor's degree in Criminal Justice</li>
<li>High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud</li></ul></li><li>
Ability to be properly licensed as a Private Investigator as required by the state where work Is completed</li>
<li>Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course</li>
<li>Minimum of five (5) years of demonstrated experience conducting complex insurance investigations or adjusting complex insurance claims</li>
<li>Proficient understanding and application of anti-fraud laws, insurance regulations, and compliance standards within their home state and designated regional area.</li>
<li>Proficient in utilizing laptop computers and cell phones.</li>
<li>Special Investigative Unit (SIU) Compliance knowledge</li>
<li>Ability to type 40+ words per minute with minimum error</li>
<li>Flexibility to work varied and irregular hours and days including weekends and holidays</li></ul><p><b>
PREFERRED QUALIFICATIONS (NICE TO HAVE):</b>
</p><ul><li>Military experience</li>
<li>Law enforcement</li>
<li>Insurance administration experience</li>
<li>Familiarity with California SIU regulations</li>
<li>One or more of the following professional industry certifications:</li><li><ul><li>
Certified Fraud Investigator (CFE)</li>
<li>Certified Insurance Fraud Investigator (CIFI)</li>
<li>Fraud Claim Law Associate (FCLA)</li>
<li>Fraud Claim Law Specialist (FCLS)</li>
<li>Certified Protection Professional (CPP)</li>
<li>Associate in Claims (AIC)</li>
<li>Chartered Property Casualty Underwriter (CPCU)</li></ul></li></ul><p><b>
BENEFITS:</b>
</p><ul><li>Medical, dental, vision, basic life, AD&amp;D, retirement plan and disability insurance</li>
<li>Seven paid holidays annually, sick days available where required by law</li>
<li>Vacation time offered at an initial accrual rate of 3.08 hours biweekly; unused vacation is only paid out where required by law</li></ul><h2 class="jobSectionHeader"><b>
Closing</b></h2><p>
Allied Universal&reg; is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: www.aus.com
</p><p>If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: www.aus.com/offices.</p><h2 class="jobSectionHeader"><b>
Requisition ID</b></h2><br>
2026-1574656</div>

SIU Investigator

Onco360

<div><div>Join our Growing Team making a difference in our Patient Lives! Onco360 is looking for a <b>Customer Care Specialist</b> based out of our Houston, TX<b> </b>pharmacy. This is a full-time position working hours between 8am-8pm<b> CST Monday through Friday and availability on Saturday and Sundays for hours between 8am-4:30pm CST.</b> <b>This is a remote work from home position with training at the Houston pharmacy.</b> Customer Care Specialists at Onco360 will work with the sales team and providers in monitoring all customer care issues.</div>
<div></div><div><div><b>Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturer</b><b>s.</b></div>
<div><div>A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion.</div>
<div></div><div>We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.</div>
</div>
<div></div><div><b>Starting salary from $22.00 an hour and up</b></div>
</div><div></div><div><div>We offer great benefits including:</div>
<ul><li>Medical; Dental; Vision</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Company paid benefits &ndash; life, and short and long-term disability</li>
</ul><div>Customer Care Specialist Responsibilities:</div>
<ul><li>Manages the customer care escalations email workflow.</li>
<li>Works with the customer service manager to ensure all sales team escalations are addressed daily.</li>
<li>Work all address exception reports given by the VP of pharmacy operations.</li>
<li>Report to the customer care manager any items that may cause escalations not to be completed.</li>
<li>Have knowledge of CPR+ and billing claim responses.</li>
<li>Escalate all issues to the proper pharmacy director, sales team rep or analytics team.</li>
<li>Work with other functional areas to resolve customer problems, and in system databases, and notifying appropriate parties as to what action will be taken to resolve the problem.</li>
<li>Work all projects that are assigned by the customer service manager</li>
</ul><div>Position Qualifications for Customer Care Specialist:</div>
<ul><li>Education/Learning Experience
<ul><li>High School Diploma required; Bachelor's degree preferred</li>
</ul></li><li>Work Experience
<ul><li>1 to 2 years of pharmacy billing or certified pharmacy technician required</li>
</ul></li><li>Skills/Knowledge
<ul><li>Customer service, problem solving, and excellent communication skills verbal and writing required.</li>
<li>Work independently with little to no guidance</li>
</ul></li><li>Licenses/Certifications
<ul><li>Required: State Pharmacy Technician (as required) and national Pharmacy Technician certification (PTCB or equivalent)</li></ul></li></ul></div></div>

Pharmacy Technician - Customer Care Specialist

Elite Spine and Health Center

<p>Are you passionate about movement, recovery, and helping people feel their best?</p><p>At <b>Elite Spine and Health Center</b>, we don&rsquo;t just treat patients &mdash; we create <b>raving fans</b> through an unmatched, high-energy, and results-driven experience.</p><p>We are looking for a <b>Rehab Specialist</b> to join our <b>West Houston location</b> &mdash; someone who thrives in a fast-paced environment, loves hands-on patient care, and is ready to step into a dynamic role while continuing to grow clinically.</p><p><b>Why Join Elite Spine?</b></p><ul><li>Be part of a <b>modern, high-performance clinic</b> with state-of-the-art technology</li><li>Work alongside a <b>supportive, growth-minded team</b></li><li>Get <b>hands-on mentorship from doctors</b> and leadership</li><li>Make a real impact helping patients <b>heal faster and move better</b></li><li>Clear pathway for <b>career growth in rehab, chiropractic, and integrated care</b></li></ul><p><b>What You&rsquo;ll Do</b></p><p>As a Rehab Specialist, you&rsquo;ll play a key role in both <b>patient care and leadership</b>:</p><p><b>Patient Care</b></p><ul><li>Lead patients through <b>corrective exercises</b> tailored to their recovery</li><li>Guide <b>stretching, mobility, and movement retraining</b></li><li>Perform <b>soft tissue work</b> to support healing and recovery</li><li>Administer advanced modalities:</li><li>Electrical stimulation</li><li>Ultrasound</li><li>Heat / Cold therapy</li><li>Intersegmental traction</li><li><b>Shockwave therapy</b></li><li><b>Class IV Laser</b></li><li><b>Spinal decompression</b></li><li>Educate patients on <b>injury prevention and long-term wellness</b></li></ul><p><b>Leadership &amp; Operations</b></p><ul><li>Assist with <b>clinical oversight and patient flow</b></li><li>Help maintain a <b>high-energy, organized rehab environment</b></li><li>Support <b>chart audits and quality of care standards</b></li><li>Lead by example with <b>exceptional patient experience</b></li></ul><p><b>What We're Looking for in a Rehab Specialist</b></p><ul><li>A <b>leader</b> who takes initiative and supports the team</li><li>High-energy, positive, and thrives in an <b>upbeat culture</b></li><li>Passionate about <b>rehab, movement, and patient outcomes</b></li><li>Able to handle a <b>fast-paced, high-volume environment</b></li><li>Strong communicator who connects easily with patients</li></ul><p><b>Preferred Background</b></p><ul><li>Degree in <b>Exercise Science, Kinesiology, Athletic Training, Sports Medicine</b>, or related field</li><li>OR equivalent experience in rehab, fitness, or manual therapy</li><li><b>1&ndash;2+ years experience</b> in athletic training, rehab, or similar field</li></ul><p>Ideal for aspiring:</p><ul><li>Athletic Trainers (ATC)</li><li>Physical Therapists / PTAs</li><li>Occupational Therapists</li><li>Chiropractors</li><li>Strength &amp; Conditioning professionals</li></ul><p><b>Schedule</b></p><ul><li>Full-time, 8-hour shifts</li><li>Monday &ndash; Friday</li><li>In-person at <b>Houston, TX (77042)</b></li><li>Must be able to reliably commute or relocate</li></ul><p><b>Conditions We Treat</b></p><ul><li>Orthopedic injuries</li><li>Sports injuries</li><li>Chronic pain conditions</li><li>Post-injury rehabilitation</li></ul><p><b>Benefits</b></p><ul><li>Complimentary in-office services</li><li>Paid Time Off + Paid Holidays</li><li>Health Insurance options</li><li>Ongoing training &amp; <b>career advancement opportunities</b></li></ul><p><b>Ready to Level Up?</b></p><p>If you&rsquo;re looking for more than just a job &mdash; and want to be part of a team that is redefining rehab and patient care &mdash; we want to meet you.</p><p><b>Apply today and come experience what it means to truly &ldquo;Feel the Difference.&rdquo;</b></p><p>Pay: From $16.00 per hour</p><p>Benefits:</p><ul><li>Dental insurance</li><li>Employee discount</li><li>Health insurance</li></ul><p>Work Location: In person</p>

Rehab Specialist (Rehab Technician)

CCMSI

<div><h2 class="jobSectionHeader"><b>Overview
</b></h2><div><div><div><div><b>Claim Representative, Medical Only</b></div><div><b>
Location:</b> Houston, Texas</div><div><b>
Schedule: </b>8:00 am - 4:30pm (CST) - Hybrid Schedule after initial training period (2 days in- office per week)</div><div><b>
Salary Range: </b>$20-24/hour</div><p></p><div><b>
Build Your Career With Purpose at CCMSI</b></div><div></div><div><br>
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.</div><div></div><div><br>
We don&rsquo;t just process claims&mdash;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 <i>Great Place to Work&reg;</i>, and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day.</div><div></div><div><b><br>
Job Summary</b></div><div></div><div><br>
Manages designated medical-only claims and supports claims staff, with opportunity for development and promotion to Medical Only Claim Representative II or Claim Associate I. Accountable for delivering quality claim services that meet CCMSI corporate standards and client expectations.</div><br>
<div></div>
</div></div></div><h2 class="jobSectionHeader"><b>Responsibilities
</b></h2><div><div><div><ul><li>Set up and manage medical files only in accordance with corporate claim standards and law.</li><li>
Establish reserves and/or provide reserve recommendations within established authority levels under direct supervision.</li><li>
Review and approve related medical and miscellaneous invoices on designated claims. Negotiate any disputed bills/invoices for resolution under direct supervision.</li><li>
Request and monitor medical treatment of designated claims in accordance with corporate claim standards.</li><li>
Summarize all correspondence and medical records in claim log notes as well as file same in the appropriate claim.</li><li>
Close claim files when appropriate.</li><li>
Retrieve closed claim files and re-file in storage, as requested.</li><li>
Provide support to claim staff on client service teams.</li><li>
Compliance with Corporate Claim Standards and special client handling instructions as established.</li><li>
Performs other duties as assigned.</li></ul>
</div></div></div><h2 class="jobSectionHeader"><b>Qualifications
</b></h2><div><div><div><div><b>Required:</b></div><ul><li>
Associate degree OR two (2) years of related business experience</li><li>
Ability to manage medical‑only claims cradle‑to‑grave</li><li><b>
Active Texas Adjuster License</b></li><li>
Strong attention to detail and organization skills</li><li>
Ability to follow established procedures and meet deadlines</li><li>
Proficiency with Microsoft Office (Word, Excel, Outlook)</li><li>
Strong written and verbal communication skills</li><li>
Reliable, predictable attendance during scheduled hours</li><li>
Ability to work in a fast‑paced, in‑office environment</li></ul><div><b>
Nice to Have:</b></div><ul><li>
Prior medical‑only or workers&rsquo; compensation claims experience</li><li>
Knowledge of medical terminology</li><li>
Experience working with multiple clients or industries</li><li>
Prior experience in a TPA environment</li><li><b>
Bilingual (Spanish)</b> Proficiency- Highly valued for communicating with claimant, employers, or vendors. Not required.</li></ul><h2 class="jobSectionHeader"><b>
Why You&rsquo;ll Love Working Here</b></h2><ul><li>4 weeks (Paid time off that accrues throughout the year in accordance with company policy) + 10 paid holidays in your first year</li><li>Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance</li><li>Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP)</li><li>Career growth: Internal training and advancement opportunities</li><li>Culture: A supportive, team‑based work environment</li></ul><h2 class="jobSectionHeader"><b>
How We Measure Success</b></h2><div>
At CCMSI, medical‑only claim professionals succeed through accuracy and consistency. Success in this role is measured by:</div><div><ul><li><br>
<b>Queue management</b> &ndash; timely handling of assigned medical‑only claims</li><li><b>Audit performance</b> &ndash; compliance with corporate standards and NM regulations</li><li><b>Accuracy &amp; documentation</b> &ndash; clear, complete, and timely claim notes</li><li><b>File progression</b> &ndash; appropriate reserve activity and timely claim closure</li><li><b>Team support &amp; reliability</b> &ndash; responsiveness and dependable in‑office attendance</li><li><b>Cultural alignment</b> &ndash; recognizing that every claim represents a real person</li></ul></div><div></div><div><b><br>
This is where we shine, and we hire claim professionals who want to shine with us.</b></div><div></div><div><b><i><br>
Compensation &amp; Compliance</i></b></div><div></div><div><i><br>
The posted salary reflects CCMSI&rsquo;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.</i></div><div><i>
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.</i></div><div></div><div><i><br>
CCMSI posts internal career opportunities in compliance with applicable state and local promotion transparency laws.</i></div><div></div><div><b><i><br>
Visa Sponsorship:</i></b><i> CCMSI does not provide visa sponsorship for this position.</i></div><div><b><i>
ADA Accommodations:</i></b><i> CCMSI is committed to providing reasonable accommodations throughout the application and hiring process.</i></div><div><b><i>
Equal Opportunity Employer:</i></b><i> CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations.</i></div><div></div><div><i><br>
Background checks, if required for the role, are conducted only after a conditional offer and in accordance with applicable fair chance hiring laws.</i></div><div></div><div><b><br>
Our Core Values</b></div><div>
At CCMSI, we believe in doing what&rsquo;s right&mdash;for our clients, our coworkers, and ourselves. We look for team members who:</div><div><b><br>
Lead with transparency</b> &ndash; We build trust by being open and listening intently in every interaction.<br>
<b>Perform with integrity</b> &ndash; We choose the right path, even when it is hard.<br>
<b>Chase excellence</b> &ndash; We set the bar high and measure our success. What gets measured gets done.<br>
<b>Own the outcome</b> &ndash; Every employee is an owner, treating every claim and decision as our own.<br>
<b>Win together</b> &ndash; Our greatest victories come when our clients succeed.</div><div></div><div><b><br>
We don&rsquo;t just work together&mdash;we grow together. If that sounds like your kind of workplace, we&rsquo;d love to meet you.</b></div><div></div><div><br>
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Claim Representative, Medical Only

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