CCMSI

Claim Associate

US-AZ-Phoenix
Job ID
2017-2227
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 Claim Associate investigates and evaluates contested medical-only claims and handles mostly non-litigated indemnity cases under close supervision. This position may be used as a training position for consideration of promotion to a Claim Associate II / Claim Representative Trainee. Accountable for the quality of claim service as perceived by CCMSI clients and within Corporate Claim Standards.

Responsibilities

  • Investigate, evaluate and adjust medical only claims, contested medical-only claims and handle a maximum of 30 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.

  • 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.

  • 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.

  • Will act as a back-up to designated adjusters when needed.

  • Performs other duties as assigned.

 

Qualifications

Education and/or Experience   

  • Associate Degree or two year's related business experience.
  • Medical terminology required.
  • Typing, ten key skills, and math skills required.
  • Excellent oral and written communication skills required.
  • Ability to operate general office equipment and perform clerical duties. 
  • Professional manner and appearance required. 
  • Individual must be detail oriented and a self-starter with strong organizational abilities. 
  • Ability to coordinate and prioritize required. 
  • Flexibility, accuracy, 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.                                                            

Computer Skills   

Proficient in Microsoft Office                               

 

Certificates, Licenses, Registrations

None required

 

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.

 

Other Physical Demands

  • Work requires the ability to stoop, bend, reach and grab with arms and hands, manual dexterity,

       

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 included Medical, Dental, Vision, Prescription Drug, Flexible Spending, Life, ESOP and 401K.

 

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