CCMSI

  • Claim Representative, Medical Only

    Job Location(s) US-FL-Maitland
    Job ID
    2018-2460
    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 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 direct supervision.
    • Review and approve related medical and miscellaneous invoices on designated claims. Negotiate any disputed bills/invoices for resolution under direct supervision.
    • Request and monitor medical treatment of designated claims in accordance with corporate claim standards.
    • 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.
    • Provide support to claim staff on client service teams.
    • Compliance with Corporate Claim Standards and special client handling instructions as established.
    • Performs other duties as assigned.

    Qualifications

    Education and/or Experience   

    Associate Degree or two (2) year's related business experience required

    Knowledge of medical terminology preferred. 

                                                               

    Computer Skills   

    Proficient using Microsoft Office products such as Word, Excel, Outlook                               

     

    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
    • Work requires the ability to sit or stand up to 7.5 or more hours at a time

       

      Work requires sufficient auditory and visual acuity to interact with others

          

     

    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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    If you are unable to locate a position that you are interested in that meets your qualifications, Connect with CCMSI for general consideration.