CCMSI

Claim Representative, Medical Only Senior

US
Job ID
2017-2154
Category
Claims

Overview

Cannon Cochran Management Services, Inc. (CCMSI) is a leading Third Party Administrator in self-insurance services headquartered in Danville, IL.    We are guided by core values including integrity, insisting on excellence and being passionately focused on customer service.    Those values, coupled with our Employee Stock Ownership Plan (ESOP), engage ownership with our employees and offers top of the line customer service for both our internal and external clients.

 

This is a perfect opportunity to work in a growing, dynamic work environment.  CCMSI’s emphasis is on customer service and you will be expected to set and achieve performance goals in a challenging and growing team environment.

 

The Senior 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 files only in accordance with corporate claim standards and law.
  • Establish reserves and/or provide reserve recommendations within established authority levels under minimal supervision.
  • Review and approve related medical and miscellaneous invoices on designated claims.  Negotiate any disputed bills/invoices for resolution under minimal supervision.
  • Set up designated claims files and complete all set up instructions, as requested.
  • Review and maintain personal diary on claim system.
  • Request and monitor medical treatment of designated claims in accordance with corporate claim standards.
  • Return provider phone calls.
  • Summarize all correspondence and medical records in claim log notes as well as file same in the appropriate claim.
  • Close claim files when appropriate.
  • Retrieve closed claim files and re-file in storage, as requested.
  • Delivery of quality claim service to clients.
  • Client Satisfaction
  • Provide support to claim staff on client service teams.
  • Compliance with Corporate Claim Standards and special client handling instructions as established.
  • May be required to handle more sophisticated or national accounts with more stringent claim handling service instructions.
  • May be required to handle multiple jurisdictions within caseload.
  • Perform/assist with claim audits for Medical Only I and II adjusters as needed.
  • Train newly hired/promoted Medical Only adjusters.
  • Work with Medical Only I and II adjusters as needed to develop an action plan(s) to achieve any necessary improvement.
  • Special projects and in depth research as requested.
  • Technical supervision of designated claim files.
  • Work with minimal supervision and direction.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

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.

 

Education and/or Experience                                                                 

Associates degree or two year’s related business experience required.

Knowledge of medical terminology preferred.

 

Computer Skills             

Proficient with Microsoft Office programs. 

 

Certificates, Licenses, Registrations  

None

 

 

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

 

Object Handling Categories

Work requires the ability to lift/carry objects routinely as follows:

       Light Lifting:  No lifting of objects weighing more than 15 pounds on a regular basis.

 

 

CORE VALUES & PRINCIPLES

Responsible for upholding the CCMSI Core Values & Principles which include: performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity; insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better; and leading by example.

 

CCMSI is an Affirmative Action / Equal Employment Opportunity employer offering an excellent benefit package including Medical, Dental, Prescription Drug, Vision, Flexible Spending, Life, ESOP and 401K. 

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