Claim Assistant

Ccmsi • Maitland, FL

20d • $18 - $19 • Onsite

About The 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. The Claim Assistant will investigate and evaluate contested medical-only claims and handle indemnity cases under close supervision. 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 service as perceived by CCMSI clients and within Corporate Claim Standards.

Requirements

• Excellent oral and written communication skills.
• Individual must be a self-starter with strong organizational abilities.
• Ability to coordinate and prioritize required.
• Ability to operate general office equipment and perform clerical duties.
• Flexibility, initiative, and the ability to work with a minimum of direct supervision a must.
• Discretion and confidentiality required.
• Ability to work as a team member in a rapidly changing environment.
• Reliable, predictable attendance within client service hours for the performance of this position.
• Responsive to internal and external client needs.
• Ability to clearly communicate verbally and/or in writing both internally and externally.
• Associate’s degree or two year’s related business experience.
• Proficient with Microsoft Office programs.
• Adjusters license may be required based upon jurisdiction.

Nice To Haves

• Knowledge of medical terminology preferred.
• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.

Responsibilities

• Investigate, evaluate and adjust contested medical-only claims and handle indemnity claims under direct supervision.
• Establish reserves and/or provide reserve recommendations within established authority levels under direct supervision.
• Set up designated claim files and complete all set up instructions, as requested.
• Set up independent medical exams as deemed necessary under direct supervision.
• Request and monitor medical treatment of designated claims in accordance with corporate claim standards.
• Review and approve related medical, legal, damage estimates and miscellaneous invoices on designated claims.
• Negotiate any disputed bills/invoices for resolution under direct supervision.
• Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws under direct supervision, when appropriate.
• As appropriate, make referrals to outside vendors on designated cases under direct supervision. (i.e. legal, surveillance, case management, etc.)
• Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the claim adjustment process.
• Authorize and make payments on claims utilizing a claim payment program in accordance with industry standards and within established authority levels under direct supervision.
• Compute disability rates in accordance with state laws under direct supervision, when appropriate.
• Summarize all correspondence and medical records in claim log notes as well as file same in the appropriate claim.
• Return provider calls.
• Review and maintain personal diary on claim system.
• Provide technical and clerical claims support to designated clients, as requested.
• Compliance with corporate claim standards and special client handling instructions as established.

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree
• Number of Employees: 1,001-5,000 employees