Medical Only Claims Representative – Workers’ Compensation (NV Jurisdiction)
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 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.
Requirements
- 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 Haves
- 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.
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.
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
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
