Claim Representative, Medical Only Senior

Claim Representative, Medical Only Senior

Location: Phoenix, AZ

Schedule: 8:00am - 4:30pm (MST) Hybrid schedule after initial training period (one day a week in-office)

Salary Range: $50,000 - $65,000 (depending on experience, paid out hourly)

Build Your Career With Purpose  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.

Manages designated medical-only claims and provides support to claims staff. Serves as a developmental role with potential advancement to an intermediate claims position. Responsible for delivering high-quality claim service in alignment with CCMSI client expectations and corporate claim standards.

• Manage and administer designated medical-only claims in compliance with corporate claim standards and applicable laws
• Establish and maintain appropriate reserves within authority limits or provide reserve recommendations
• Review, approve, and negotiate medical and related invoices to ensure accurate and timely payment resolution
• Set up new claim files and ensure all required documentation and system entries are completed accurately
• Maintain claim activity through detailed diary management and timely follow-up
• Coordinate, request, and monitor medical treatment in accordance with established guidelines
• Respond promptly to provider and stakeholder inquiries, including return phone calls
• Document and summarize correspondence, medical records, and claim activity in file notes and maintain organized claim files
• Close claims appropriately and assist with file retrieval and storage as needed
• Deliver high‑quality claim service aligned with client expectations and corporate standards
• Adhere to all corporate claim procedures and specialized client handling instructions
• Support client service teams and contribute to overall client satisfaction
• Provide support and technical guidance to claim staff
• Assist with claim audits and quality reviews for Medical Only I and II adjusters
• Train and mentor newly hired or promoted adjusters
• Partner with team members to develop and implement performance improvement plans as needed
• Handle more complex claims, including national accounts, as assigned
• Manage claims across multiple jurisdictions when required
• Participate in special projects and conduct in-depth research as requested
• Exercise technical oversight of designated claim files
• Work independently with minimal supervision while maintaining high performance standards

• Strong oral and written communication skills
• Arizona Adjuster License
• ICA Arizona Adjuster Authorization
• 5 or more years handling medical only claims
• Self‑motivated with the ability to work independently and take initiative
• Excellent organizational, coordination, and prioritization skills
• Ability to operate general office equipment and perform clerical tasks
• Demonstrated flexibility and adaptability in a fast‑paced, changing environment
• Ability to work effectively with minimal direct supervision
• High level of discretion with the ability to maintain confidentiality
• Strong teamwork and collaboration skills
• Reliable and consistent attendance within designated client service hours
• Commitment to delivering responsive, high‑quality service to internal and external clients
• Ability to communicate clearly and professionally, both verbally and in writing, with all stakeholders

• Bilingual (Spanish) proficiency – highly valued for communicating with claimants, employers, or vendors
• Experience supporting municipal accounts is a plus
• Knowledge of medical terminology
• Prior experience in a claims or medical role

• 4 weeks of paid time off that accrues throughout the…