Medical Only Claim Representative

Location: St. Louis, MO – Hybrid (In-Office Daily for Training, then 3 Days In-Office / 2 Days Remote)
Schedule: Monday–Friday, 8:00 AM–4:30 PM CST (37.5 hours per week)
Salary Range: $20.50–$21.50 per hour

At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts. Certified as a Great Place To Work, our employee satisfaction and retention ranks in the 95th percentile.    

Reasons you should consider a career with CCMSI:

• Culture: Our Core Values are embedded into our culture of how we treat our employees as a valued partner-with integrity, passion and enthusiasm.
• Career development: CCMSI offers robust internships and internal training programs for advancement within our organization.
• Benefits: Not only do our benefits include 4 weeks paid time off in your first year, plus 10 paid holidays, but they also include Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP.
• Work Environment: We believe in providing an environment where employees enjoy coming to work every day, are provided the resources needed to perform their job and claims staff are assigned manageable caseloads.

We are seeking a detail-oriented Claim Representative, Medical Only to join our St. Louis, MO team. This role is responsible for handling medical-only workers’ compensation claims across multiple accounts and industries, primarily in Missouri, Illinois, and Indiana jurisdictions. After an initial training period of up to six months in-office, this position offers a hybrid schedule of three days in-office and two days remote each week.

• 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.

Required:

• Strong typing and data entry accuracy.

• Excellent phone, communication, and customer service skills.

• Ability to multitask and manage competing priorities in a fast-paced environment.

Nice to Have:

• Familiarity with medical terminology.

• Previous claims or insurance-related experience.

Performance Metrics

• Claim accuracy and timeliness as measured by internal audits.

• Quality and consistency of work as evaluated by supervisor review.

What We Offer

• Employee Stock Ownership Plan (ESOP) – employee-owned company.

• Competitive hourly pay with hybrid flexibility after training.

• Comprehensive benefits package including health, dental, and vision insurance.

• Paid time off, paid holidays, and 401(k) retirement savings.

• Opportunities for career growth and advancement within CCMSI.

Compensation & Compliance

The posted salary reflects CCMSI’s good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.

CCMSI offers a comprehensive benefits package, which will be reviewed during the hiring process. Please contact our hiring team with any questions about compensation or benefits.

Visa Sponsorship:

CCMSI does not provide visa sponsorship for this position.

ADA Accommodations:

CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. If you need assistance or accommodation, please contact our team.

Equal Opportunity Employer:

CCMSI is an Affirmative Action / Equal Employment Opportunity employer. We comply with all applicable employment laws, including pay transparency and fair chance hiring regulations. Background checks are conducted only after a conditional offer of employment.

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