Medical Claims Representative – Workers NV Jurisdiction

Overview

Medical Only Claim Representative

Location:

Hybrid – Carson City, NV or Reno, NV (Nevada workers’ compensation jurisdiction only)

Schedule:

Monday–Friday, 8:00 AM–4:30 PM (37.5 hours/week)

Salary Range: $22 to $25/hr (hourly position)

Build Your Career With Purpose at CCMSI

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.

• 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.

What You’ll Bring...

Required

• 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 Have

• 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.

• 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

At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by:

• Quality claim handling – thorough investigations, strong documentation, well-supported decisions
• Compliance & audit performance – adherence to jurisdictional and client standards
• Timeliness & accuracy – purposeful file movement and dependable execution
• Client partnership – proactive communication and strong follow-through
• Professional judgment – owning outcomes and solving problems with integrity
• Cultural alignment – believing every claim represents a real person and acting accordingly

This is where we shine, and we…